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Food 


Health  and  Disease 


I.    BURNEVr    YEO,    M.D.,   P.E.C.P. 

KXAMINKR   IN   MEDICISE   AT  THE   ROYAL   COLLEGE   OF   PHYSICIANS; 

PROFESSOR  OF  CLINICAL  THERAPEUTICS    IN  KING's  COLLEGF,  LONDON,  AND 

PHYSICIAN  TO  king's  COLLEGE  HOSPITAL 

AUTHOR   OF   "a   manual   OF    MEDICAL  TREATMENT,"   ETC. 


s-a  ^  K. 


WITU    ILLUSTRATIONS 


NEW     AND     REVISED     EDITION 


PHILADELPHIA 


LEA      BROTHERS     &     CO. 


V4  je 


Co 

SIR  WILLIAM  ROBERTS,   M.D.,   F.R.S. 

IN    ADMIRATION    OF   HIS 

MASTEKLY    KESEAKCHE8    IN    PRACTICAL    DIETETICS, 

THIS    HUMiiLE    CONTRIBUTION    TO    THE    STUDY    OF    THAT    SUBJECT 

IS   DEDICATED. 


PEEFACE    TO    THE    EEVISED 
EDITION. 


The  first  edition  of  this  work  appeared  in  1889. 
Since  then  several  reprints  have  been  called  for,  in 
which  no  noteworthy  changes  liave  been  made.  It 
has,  however,  seemed  advisable,  in  preparing  the 
present  edition,  to  make  certain  changes  and  addi- 
tions. In  the  first  Part  a  few  unimportant  details 
have  been  omitted  with  the  view  especially  of  gaining 
space  to  deal  more  fully  with  the  practical  subjects  of 
the  second  Part.  In  that  Part  of  the  book  some  im- 
portant additions  have  been  made,  and  two  entirely 
new  chapters  introduced,  and  the  subject  of  the 
sterilisation  of  milk  has  been  dealt  with  in  an  ad- 
ditional appendix.  The  author  trusts  that  the  work 
may  thus  be  rendered  more  useful  and  more  worthy 
of  the  favoui"  with  which  it  has  been  received. 

44,  Hertford  Street,  May/air, 
June,  1896. 


PEEFACE   TO   THE   FIEST 
EDITION. 

In  writing  this  work  on  Food,  the  object  I  have 
especially  aimed  at  has  been  to  make  it  one  of  prac- 
tical utility,  and  to  render  it,  as  far  as  possible,  repre- 
sentative of  the  modern  aspects  of  the  subject  it  treats 
of.  In  a  hand-book  like  this,  which  has  necessarily 
to  be  kept  within  strictly  allotted  limits,  compression 
in  certain  points  has  been  essential  in  order  to  obtain 
space  to  give  adequate  development  to  the  more 
generally  interesting  details  of  practical  dietetics. 

I  have  thought  it  desirable,  in  the  first  part  of  the 
book,  to  enter  fully  and  in  detail  into  the  important 
subjects  of  Army  and  Prison  Dietaries,  School 
Dietaries,  and  Feeding  duruig  the  critical  period  of 
Infancy  and  Childhood. 

The  second  part  of  the  book  is,  to  some  extent, 
founded  on  a  short  course  of  lectures  on  "The 
Therapeutics  of  Food,"  which  it  was  my  duty  to  give 
in  King's  College  Hospital  as  Professor  of  Clinical 
Therapeutics. 

In  preparing  this  Manual  I  have  been  under  great 
obligations  to  many  contemporary  writers  on  Dietetics. 
To  the  writings,  amongst  others,  of  Bauer,  Konig, 
Landois,  Oertel,  Dujardin-Beaiimetz,  Germain  See, 
Weir  Mitchell,  Parkes,  Pavy,  Sir  Henry  Thompson, 
and  Sir  William  Roberts,  I  am  deeply  indebted. 

The  subject  matter  of  this  work  does  not  lend 
itself  well  to  orderly  classification.  Few  previous 
writers  on  Dietetics  have  attempted  any.  I  have, 
however,  thought  it  would  be  practically  convenient 
to  arrange  the  subjects  dealt  with  under  two  main 
divisions — Food  in  Health,  and  Food  in  Disease. 

I  can  only  hope  this  book  will  be  found  to  be — 
what  I  have  endeavoured  to  make  it — a  practically 
useful  guide  to  the  study  of  the  important  subject  of 
Dietetics. 


COKTEISTTS. 


PART  I.    FOOD  IN  HEALTH. 

CHAPTER  PAQB 

I.    The  Nature,  Origin,  and  Purpose  op   Food — 

Classification  of  Food — Metabolism      .        .        1 
II.    The  Nutritive  Value  and  Uses  of  the  Different 

Classes  op  Food 12 

ORDINARY   ARTICLES   OF  FOOD   AND  DRINK. 

III.  Animal  Foods 32 

IV.  Vegetable  Foods 66 

V.    Beverages.       » 96 

Condiments 130 

VI.    The  Annexation  op  Food  :  Its  Digestion,  Assimi- 
lation, AND  Utilisation 132 

VII.    The  Cooking,  Preparation,  and  Preservation 

op  Food 155 

VIII.    The  Scientific  Basis  of  Dietaries  and  Rations    185 
IX.    Certain  Dietaries  :  Prison  Dietaries — Soldiers' 

Dietaries— Seaj^n's  Dietaries        .        .        .    210 
X.    The  Order  and  Freqitency  of  taking  Food       .    234 
XI.    Food  in  Relation  to  Age  and  Condition— Food 
IN  Infancy  and  Childhood— Food  at  School 
—Food  in   Adult  Life— Food  in  Advanced 

Age 240 

XII.    The  Relative  Advantages  op  Animal  and  Vege- 
table Foods— Vegetarianism    ....    289 


viii  Food  in  Health  and  Disease. 

PART  11.     FOOD  IN  DISEASE. 

CHAPTER  PAOB 

Introductory  Remarks 300 

I.  Feeding  in  Acute  Diseask  and  Convalescence  .  .302 
II.  The  Dietetic  Treatment  ok  Diseases  oe  the 
Digestive  Organs  —  Acute  and  Chronic 
Gastric  Catarrh— Gastric  Ulcer — Cancer  of 
Stomach— Dilatation  ob'  the  Stomach— Dys- 
pepsia—Conktipation — DiARRHtEA      .        .        .     326 

III.  Food  in  Diabetes 363 

Diabetic  Dietaries 396 

IV.  Diet  in  Albuminuria 405 

V.    Diet  in  Gout  and  Calculous  Disorders     .        .    421 

VI.    The  Dietetic  Treatment  of  Obesity    .        .        .    439 
VII.    Diet  in  An.emia,  Chlorosis,  Neurasthenia,  and 

Allied  Disturbances  of  Nutiution         .        .    459 
VIII.    Food  in  Rickets,  Scur\%  Scrofula,  Consumption, 
and   Chronic   Febrile   Con rniioNS  — Forced 
Feeding  (Suralimentation)       .        .        .        .474 
IX.    Diet   in  Affections  of  the  Circulatory  and 

Respiratory  Organs 494 

X.  Food  in  Acute  and  Chronic  Rheum.atism  and  in 
Rheumatoid  Arthritis— In  Skin  Diseases— 
In  Insanity  and  certain  other  Affections 
OF  the  Nervous  System— Beneke's  Diet  for 

Cancer 508 

XI.    Certain  Special  Dietetic  Cures  :    The  "  Dry  " 
Cure— Milk  and  Whey  Cures— The  Koumiss 
Cure— The  Grape  Cure     .        .       7'      .        .523 
XII.    On  Artificial  Digestive  Agents  and  on  Arti- 
ficial Alimentation 535 

Appendix  I.    Hospital  Dietaries 549 

,,        II.    The   Sterilisation   and    Pasteurisation 

of  Milk 557 

„       III.    Invalid's  Dietary— Select  Recipes  .        .    564 
IKDBX 577 


Food  in  Health  and 
Disease. 

POOD    IN    HEALTH. 


CHAPTER     I. 

THE   NATURE,   ORIGIN,    AND   PURPOSE   OF  FOOD — CLASSI- 
FICATION  OF   FOOD — METABOLISM. 

All  living  things  undergo  change.  Change  is  a 
necessary  condition  of  growth  and  development,  of 
decay  and  of  repair.  Change,  change  of  substance, 
is,  then,  a  necessary  and  constant  condition  of  life 
t^nd  activity. 

In  the  living  and  normally  active  body  there  are, 
therefore,  always  changes  taking  place,  losses  pro- 
ceeding from  within,  and  gains  accruing  from  with- 
out to  compensate  for  those  losses ;  otherwise  it 
would  cease  to  be  active,  it  would  cease  to  live. 

These  gains  from  without  are  derived  from  what 
we  call  Food,  and  the  purpose  of  food  is  to  supply 
the  living  organism,  however  complex  or  however 
simple  it  may  be,  with  the  substances  or  elements 
necessary  for  its  growth  and  repaii',  and  for  the 
production  and  execution  of  those  forms  or  modes 
of  energy  which  we  speak  of  as  its  functions. 

A  perfect  and  complete  food  for  any  living  thing 
must  necessarily  comprise  all  the  elements  of  which 
its  tissues  and  all  the  solids  and  fluids  of  its  body  ai"e 
composed. 


2  Food  in  Health  [rmti. 

When  its  composition  is  simple,  its  food  may  be 
simple.  The  simplest  ■vegetahle  organisms  require  for 
their  food  nothing  beyond  water  and  the  gases  of 
the  atmosphere.  The  carbon  and  nitrogen  which 
enter  into  the  composition  of  their  simple  structures 
are  derived  from  the  carbonic  acid  and  the  minute 
quantity  of  anmionia  alsvays  found  in  the  atmo- 
i-phere,  and  in  solution  in  rain-water. 

But  when  we  come  to  cousidcT  the  food  of  so 
complex  an  organism  as  that  of  man,  with  which  we 
are  now  mainly  concerned,  we  shall  find  his  foo  I 
requirements  to  be  correspondingly  complex. 

The  simplest  organisms  also  ap[)ropriate  their 
food  in  a  very  simple  manner;  and  in  the  whole  of 
the  vegetable  kingdom  there  is  nothing  to  be  found 
comparable  to  the  function  of  d'ujesLion  in  the  higher 
animals ;  but  in  these  latter,  most  elaborate  processes, 
mechanical  and  chemical,  are  called  into  operation  in 
the  api)ropriation  of  the  complex  substances  they  take 
as  food.  'J'hese  processes  are  comprised  in  what  are 
known  as  the   functions  of  digestion  and  assimilation. 

So,  then,  we  may  define  food  to  be  any  substance 
which,  when  introduced  into  tiie  living  organisnj,  can 
minister  to  the  maintenance  of  its  structure  and  its 
activities ;  and  a  perfect  and  complete  food  for  any 
living  bo<ly  will  be  one  which  comprises  all  the  ele- 
ments which  enter  into  the  composition  of  the  tissues, 
juices,  and  secretions  of  the  body,  as  well  as  those 
which  are  needed  for  the  maintenance  of  the  chemical 
changes  connected  with  its  functional  activity. 

In  the  young  and  growing  animal  a  considerable 
amount  of  food  is  needed  for  tlie  growth  and  develop 
ment  of  its  organs.  When  these  are  complete,  and 
growth  is  at  an  end,  food  is  needed  to  maintain  the 
integrity  of  the  body  structures,  and  to  repair  such 
waste  as  is  involved  in  the  exercise  of  their  functions  ; 
while  alike  in  the  growing  .and  in  the  mature  bo<ly, 
food  is  needed  to  supply  the  elements  necessary  for 
the  maintenance  of  those  chemical  changes  which  are 
esacntialto  the  development  of  animal  activities,  such 


Chnp.  1.]     Nature  and  Purpose  of  Food.  3 

as  muscular  and  nervous  action,  heat  formation,  nutri- 
tion, secretion,  assimilation,  and  reproduction. 

But  a  substance  in  order  to  be  suitable  for  food 
must  not  merely  possess  the  elements  indicated,  it 
must  also  contain  them  in  a  mode  or  combination 
wliich  enables  them  to  be  apj^ropriated,  i.e.  to  be 
digested  and  assimilated,  by  the  organs  of  the  body 
it  is  to  feed.  The  plant  — the  grass  plant,  for  example 
— is  enabled  to  appropriate,  and  therefore  i~o  use  as 
food,  the  soluble  mineral  matters  of  the  soil  in  which 
it  grows,  dissolved  in  the  rain-water  which  falls  upon 
it,  together  with  what  it  absorljs  from  the  gases  of 
the  air.  It  is  a  characteristic  of  the  members  of  the 
vegetable  kingdom  that  they  are  able  to  feed  on  hior- 
ga)iic  substances.  Animal  organisms  are  unable  to 
do  so  ;  they  are  dependent  on  vegetable  oi'ganisms  to 
provide  them  with  food  that  they  can  appropriate. 

The  ox  is  enabled  to  appropriate,  and  use  as  food, 
the  grass  that  is  itself  fed  on  inorganic  substances, 
upon  which  the  ox  cannot  feed ;  and  from  this  grass 
it  is  enabled  to  build  up  structures,  and  to  i)erform 
functions  of  the  same  kind  as  those  possessed  by  man 
himself.  Yet  grass,  such  as  the  ox  feeds  on,  is  not  a 
suitable  food  for  man,  because  its  component  elements 
are  not  so  arranged  as  to  (liable  his  organs  to  digest 
and  assimilate  them ;  but,  on  the  other  hand,  the 
same  elements  having  imdergone  some  further  elabora- 
tion, as  in  the  ripe  seed  of  certain  species  of  grass, 
when  fitly  prepared,  form  one  of  the  most  useful 
foods  that  man  can  obtain,  as  the  meal  of  ■wheat, 
barley,  oats,  etc. 

Thus,  in  considering  the  origin  of  food,  we  learn 
how  the  simplest  vegetable  forms  grow  and  feed  on 
the  constituents  of  the  atmos])here  alone,  the  carbon 
and  nitrogen  of  their  tissues  being  derived  from  the 
carbonic  acid  and  ammonia  always  present  in  small 
quantity,  together  with  aqueous  vapour,  in  the  air. 

The  larger  vegetable  forms  feed  also,  to  some  ex- 
tent, on  the  gases  of  the  air,  but  they  also  feed  largely 
on  the  organic  and  inorganic  constituents  of  the  soil 
B  2 


4  Food  in  Health.  [Parti. 

in  which  they  are  planted.  The  organic  substances 
in  the  soil  consist  chiefly  of  decomposing  vegetable 
matter,  and  these  must  be  resolved  by  decomposition 
into  carbonic  acid  and  ammonia  before  they  can  be 
absorbed  by  plants.  The  animal,  unable  to  construct 
organic  substances  from  inorganic  matters,  is  depen- 
dent on  the  vegetable  kingdom  for  his  food. 

If  we  examine  the  chemical  composition  of  those 
organic  compounds  prepared  by  the  vegetable  world, 
and  which  serve  as  food  for  animals,  we  find  they 
consist  chiefly  of  the  following  elements  : — carbon, 
hydrogen,  oxygen,  nitrogen,  sulphur,  and  phosphorus. 

Of  these  elements  nitrogen  is  the  most  important, 
as  it  is  the.  essential  element  of  all  living  tilings ;  vital 
phenomena,  the  activity  and  change  characteristic  of 
all  living  things,  are  only  found  where  this  element 
is  present. 

Tliis  has  been  well  expressed  by  Parkes.  "  Every 
structure  in  the  body,"  he  says,  "  in  which  any  form 
of  energy  is  manifested  (heat,  mechanical  motion, 
chemical  or  electrical  action,  etc.)  is  nitrogenous. 
The  nerves,  the  muscles,  the  gland-cells,  the  floating 
cells  in  the  various  liquids,  the  semen,  and  the  ovarian 
cells,  are  all  nitrogenous.  Even  the  non-cellular 
liquids  passing  out  into  the  alimentary  canal  at 
various  points,  which  have  so  great  an  action  in 
preparing  the  food  in  different  ways,  are  not  only 
nitrogenous,  but  the  constancy  of  this  implies  the 
necessity  of  the  nitrogen  in  order  that  these  actions 
shall  be  performed ;  and  the  same  constancy  of  the 
presence  of  nitrogen,  when  function  is  performed,  is 
apparently  traceable  through  the  whole  world.  Surely 
such  constancy  proves  necessity." 

We  see,  then,  that  the  simplest  forms  of  vegetable 
life  derive  their  food  from  the  atmosphere  in  which 
they  live  and  grow,  the  elements  of  the  carbonic 
acid,  and  the  ammonia,  and  the  water  always  present 
therein,  sufficing  for  their  nutrition  and  growth.  Tiie 
higher  vegetable  forms,  in  addition  to  the  elements 
they  derive  from  the  constituents  of  the  atmosphere, 


Chap.  I.)  Alimentary  Principles.  5 

are  able  by  their  roots  to  absorb  and  use  as  food  the 
inorganic  salts  of  the  soil.  In  this  way,  under  the 
influence  of  the  solar  rays,  vegetable  organisms  pre- 
pare and  store  up  organic  compounds  suitable  for  the 
food  of  animals. 

Animals,  in  the  processes  of  nutrition,  and  in  the 
development  of  their  various  forms  of  energy,  feed 
upon,  that  is  to  say  appropriate,  these  products  of 
vegetable  life ;  convert  them  into  other  organic  com- 
pounds, or  decompose  them  in  the  process  of  nutrition, 
with  the  aid  of  the  cxygen  absoi'bed  from  the  air,  into 
simpler  substances,  which  are  in  coux'se  of  time  re- 
stored to  the  atmosphere  and  to  the  soil,  and  resolved 
finally  into  the  simple  elements  from  which  they 
originally  proceeded. 

It  is  not  necessar)',  for  our  present  ])U  tpo.se,  that 
we  should  pursue  the  subject  of  the  origin  and  nature 
of  food,  in  its  general  sense,  further  than  tliis.  The 
subject  of  dietetics  is  a  practical  one,  and  it  is  with  the 
question  of  food  in  relation  to  the  various  practical 
wants  of  the  human  body,  in  health  and  in  disease, 
that  we  are  now  concerned. 

The  various  organic  and  inorganic  compounds 
which  enter  into  the  composition  of  the  human  body 
may  all  be  resolved  into  the  following  thirteen  ele- 
ments : — carbon,  hydrogen,  oxygen,  nitrogen  (these 
four  in  far  greater  proportion  than  the  others),  sul- 
phur, phosphorus,  chloriiie,  iodine,  potassium,  sodium, 
calcium,  magnesium,  and  iron.  A  few  other  elements 
(such  as  fluorine,  silicon,  manganese,  etc.)  have  been 
discovered  in  the  human  body,  but  it  is  doubtful  if 
they  are  invariably  or  necessarily  present. 

All  these  thirteen  elements  must  be  represented  in 
the  food  of  man,  and  they  must  be,  for  the  most  part, 
combined  in  the  form  of  organic  products  capable  of 
being  appropriated  by  his  digestive  organs. 

Classification  of  food:  alimentary  prin- 
ciples.— In  attempting  a  general  classification  of 
foods,  it  is  convenient  and  usual  to  examine,  in  the 
first  place,  the  various  definite  compounds  which  can 


6  Food  in  Health.  (Parti. 

bo  derived  by  clienncal  analysis  from  the  different 
substances  commonly  used  as  food,  and  these  are 
termed  alimentary  princij^les. 

The  classification  generally  adopted  was  originally 
founded  on  the  analysis  of  that  perfect  and  complete 
food  U])on  which  the  young  of  all  niamnialian  animals 
for  a  time  are  fed,  and  which  is  therefore  pioved  to 
contain  all  that  is  necessary  for  supi)orting  and  main- 
taining the  growth,  develoj)ment,  and  activities  of  the 
animal  body  in  its  highest  form,  'i'hat  perfect  and 
covjplete  food  is  milk.  On  analysing  this  fluid  we 
find  :  — 

1st.  That  it  contains  a  large  quantity  of  a  prin- 
ciple rich  in  nitrogen,  termed  casein,  as  well  as  some 
other  nitrogenous  or  albuminous  substances  in  small 
quantity. 

2nd.  It  contains  a  considerable  quantity  of  oil  or 
fat  (cream  or  butter). 

3rd.  It  contains  a  form  of  sugar,  nainel}',  lactose 
or  lacfine  (milk  sugar). 

4th.  It  contains  water  holding  in  solution  various 
mineral  constituents  or  salts  (chiefly  chlorides,  phos- 
phates, and  sulphates  of  magnesium,  calcium,  potas- 
sium, sodium,  and  iron). 

Adopting  this  convenient  basis  of  classification, 
we  are  enabled  to  establish  four  great  divisions  of 
alimentary  principles,  the  members  of  each  group 
l)Ossessing  a  remarkable  similarity  of  composition, 
and  didering  widely  both  in  physical  and  chemical 
characters  from  tlie  members  of  tl:e  other  groujis. 

These  different  groups  also  appear  to  serve,  more 
or  less,  different  purposes  in  nutrition,  although  to 
some  extent  the  members  of  one  group  may  replace 
those  of  another;  and  a  combination  of  all  four 
classes  appears  to  be  necessary  for  the  maintenance 
of  the  boily  in  perfect  health. 

1.  The  first  class,  comprising  the  chief  nitrogenous 
alimentaiy  principles,  may  be  conveniently  termed 
albuminates  (albumen  being  taken  as  the  tj^ical 
mouiber  of  the  group).     These  used  at  one  time  to 


Chap.  I.]  Alimentary  Principles.  7 

be  named  proteids  (a  term  still  employed  by  many 
authors),  from  the  circumstance  that  they  could  all  be 
m.ade  to  yield  the  substance  protein,  which  is  now, 
however,  simply  regarded  as  a  product  of  chemical 
manipulation. 

The  chief  of  these  nitrogenous  alimentary  prin- 
ciples are  : — 

Blood  fibrin. 

Synionm;  ov  muscle  fibi'in. 

Mi/osiii,  from  muscle. 

Albumen  in  its  various  forms. 

Vajetablc  fibrin,  or  Gluten. 

Casein,  animal  and  vcgotalilo,  the  latter  sometimes 
termed  Lcgnniin. 

Globulin,  occurring  in  the  contents  of  the  blood  cor- 
puscles. 

The  members  of  this  class  present  a  remarkable 
uniformity  of  chemical  composition,  and  can  replace 
one  another  in  nutrition.  They  contain  from  15-9 
to  IGoperccnt.  of  nitrogen  ;  their  other  elements  being 
carbon,  hydrogen,  oxygen,  and  sulphur,  or  phosphorus. 

The  following  is  a  close  approximation  to  their 
percentage  composition  :— 

Nitrogen lo'o 

Carbon      . oSo 

Hvdrogen 70 

Oxygen 22-1 

Sulphur    .        .        .        .         .         .        .         .       1"6* 

It  is  usual  to  consider  as  nearly  related  to  tlie 
members  of  this  class  the  vsubstances  (jelatin  and 
cliondrin,  which  approach  the  albu  ininates  in  chemical 

*  Chemical  composition  of  the  allium  incites.  -The  following  lias 
been  sugge-tcd  as  a  hypothetical  general  formula  for  the  iilbu- 
minatos.  It  represents  an  albuminoid  as  a  compound  of  cellulose 
plus  ammonia  minus  water  : — 

Ca-Hi'-N-^O'  =^  2(C'H'»0^)-f3NII'  -  GH-O 

AllmmiiiDkl  Ci'lliilose        Aiiiiiioiiia    Wiitor 

Mulder's  view  that  all  these  bodies  had  a  special  principle,  which 
he  termed  protein,  as  a  bivse,  is  no  longer  accepted  ;  and  A.  Oautier 
has  advanced  the  view  (by  no  means  generally  held)  that  they  are 
built  up  on  the  Cffdno/cn  coiujiouuds  as  a  sort  of  chemical  fr.iinc- 
work,  and  that  in  the  body  tliesc  toxic  couipouuds  arc  eliminated, 
as  useless  or  dangerous,  in  the  form  of  Icucomuinca. —  I'idc  Du- 
jardin-JJcaumctz,  '' L'Hygi'jue  Alimentairo,"  p.  17- 


8  Food  in  Health.  [PartL 

coinpositjon  and  in  their  richness  in  nitrogen  ;  but 
they  liave  not  the  same  nutritive  value,  nor  can  they 
be  made  to  yield  protein.  Gelatin  is  derived  from 
bone  and  fibrous  tissues ;  and  chondrin  from  cartilage. 
They  contain  a  largei-  proportion  of  nitrogen  than  the 
albuminates. 

2.  Tlie  second  group,  the  fats,  or  hydrocarbons, 
comprise  the  various  animal  and  vegetable  fats,  oils, 
wax,  etc.  These  resemble  one  another  in  chemical 
composition,  and  are  especially  rich  in  carbon,  their 
percentage  com])ositiou  being  represented  by  the 
following  figures  :— 

Carbon 79 

Hydrogen 11 

Oxygen 10 

They  differ  somewhat  in  their  physical  state,  some 
being  solid  and  hard,  like  wax ;  others  softer,  like 
butter ;  others  quite  fluid,  as  certain  oils.  They  vary 
also  in  their  digestibility,  and  therefore  in  their  value 
as  foods. 

3.  The  third  class  comprises  all  the  starchy  and 
saccharine  substances  used  as  food,  and  these  are 
termed  carbohydrates,  from  their  chemical  composi- 
tion, in  which  hydrogen  and  oxygen  exist  in  the 
proportions  to  form  water.  The  composition  of  starch, 
which  may  be  taken  as  a  type  of  this  group,  is 

The  chief  members  of  this  class  are  : — 

The  various  vegetable  Starches. 

Cane,    Grape,    and  Milk  Sugar    (Sucrose,   Glucose,   and 

Jj-ictose). 
Gum :  Dextrin. 
Cellulose : 

together  with  a  few  other  substances  closely  related 
to  them  in  chemical  composition.  Pectin,  or  vegetable 
jelly,  is  sometimes  referred  to  this  class,  although  it 
does  not  contain  hydrogen  and  oxygen  in  the  propor- 
tions to  form  water. 

4.  The  fourth  class  includes  water  and  the  various 
viineral  substances  which  occur  in  the  animal  body. 


Chap.  I.]  ClASSIF/CA  TION  OF  FoODS.  Q 

These  four  groups  of  alimentary  principles  com- 
prise all  that  is  necessary  for  the  growth,  maintenance, 
and  activities  of  the  animal  body. 

In  addition,  however,  to  these  four  groups  may  be 
mentioned  the  various  substances  termed  yboc/  acces- 
sories, comprising  the  several  condiments  which  give 
flavour  to  food,  or  stimulate  the  digestive  secretions, 
and  the  well-known  "  stimulants,"  tea,  coffee,  cocoa, 
alcohol,  etc. 

Foods  have  also  been  classified  into  organic,  those 
derived  from  the  animal  and  vegetable  kingdoms,  and 
inorganic,  namely,  mineral  substances  or  salts ;  also 
into  nitrogenous,  those  containing  the  element  nitrogen, 
and  non-nitrogenous,  those  containing  no  niti-ogen. 

Arranged  in  tabular  form,  these  various  classifica- 
tions may  be  thus  represented  : — 


Jz5 


I 

o 

i 

JZ5 


Albuminates — Nitrogenous  substances,  having  the\ 
same  or  nearly  the  same  chemical  composition  as 
Albumen.  Examples. — Albumen,  Fibrin,  Synto- 
nin,  Myosin,  Globulin,  Casein,  from  the  Animal; 
Gluten  and  Legumin,  from  the  Vegetable  King- 
dom. 

(a)  Subordinate  nitrogenous   substances  leferrcd  to 
this  class,  and  known  as — 

Gelatin. 


Gelatigenous  substances  ^  pi  „  j  •„ 

2.  Fats  or  Hydrocarbons,  containing  Carbon,  Hydro-    g 

gen    and    Oxygen — the    pioportion    of    oxygen  i  < 
being  insufficient  to  convert  all  the  hydrogen     " 
into    water.      Examples. — Olein,   Stearin,    Jlar- 
garin  (Butter  is  a  familiar  one). 

3.  Carbo-Hydrates,  containing  Carbon,  Hydrogen  and 

Oxygen,  the  two  latter  elements  in  the  propor- 
tions to  form  water.  Examples. — Starch,  Dex- 
trin, Cane  Sugar,  Gi-ape  Sugar,  Lactose  or  Milk 
Sugar, 
(a)  The  Vegetable  Acids,  Oxalic,  Tartaric,  Citric, 
Malic,  Acetic  and  Lactic,  are  by  some  authors 
referred  to  this  class. 

4.  Mineral. 
Water. 
Salts. — Sodium  and  Potassium  Chlorides,  Calcium  and 

Magnesium  Phosphates,  Iron,  etc. 


10  Food  in  Health.  [Pan  i. 

iTIctaboliMn. — Tlie  word  "inet:vl)o]isin  "  is  often 
used  in  connection  with  the  utilisation  of  the  food 
rttceived  into  the  body. 

It  refers  in  the  first  place  to  those  phenomena 
manifested  by  all  living  oi'ganisms  in  the  exercise  of 
their  power  of  appropriating  the  substances  taken  in 
as  food  and  incorporating  them  into  the  tissues  of 
their  bodies  ;  the  process,  in  short,  of  assimilation. 
It  also  refers  to  that  power  which  the  animal  organism 
possesses  of  accumulating  from  its  food  supplies  a 
store  oi  2iotential  energy,  which  it  is  able  to  transform 
into  kinetic  energy,  and  which  manifests  itself  com- 
monly in  the  form  of  muscular  work  and  the  produc- 
tion of  heat.  It  further  includes  the  formation  of  those 
excretortj  products  which  result  from  the  changes  which 
occur  in  the  constituents  of  the  tissues  as  the  necessary 
accompaniment  of  such  tmnsformations  of  energy. 

Normal,  healthy  metabolism,  therefore,  requires  a 
due  supply  of  suitable  food,  suitable  in  quality  and 
quantity  ;  it  also  involves  the  storing  up  of  a  portion 
of  this  food  within  the  body;  and  it  demands  a  regular 
chemical  transformation  of  the  tissues,  and  the  forma- 
tion of  the  effete  excrc^toiy  pi'oducts  resulting  from 
these  changes,  which  have  to  be  eliminated  through 
the  organs  provided  for  that  purpose. 

The  term  equilibrium  of  the  metabolism  is  used  to 
signify  that  the  bodily  income  and  expenditure  are 
balanced ;  that  while  the  Jiormal  ])hysiological  condi- 
tions are  maintained,  there  is  (jxactly  the  same  amount 
of  new  material  absorbed  and  assimilated  as  there  is 
of  etfete  matter,  the  products  of  the  I'etrogressive 
tissiu;-changes,  removed  by  the  organs  of  excretion ; 
the  destruction  of  tissue  is  exactly  compensated  for 
by  the  formation  of  new  tissue.  Of  coux'se,  while  the 
body  is  growing  rapidly  there  is  greatly  increased 
formation  in  the  parts  participating  in  the  rapid 
growth,  and  the  metabolism  in  these  parts  is  corre- 
spondingly increased ;  on  the  other  hand,  during 
senile  decay  the  expenditure  is  in  excess,  and  the 
body  in  consequence  wastes. 


Chap.  I.)  Metabolism.  i  i 

The  physiological  vqidlihrium  is  practically  doter- 
mined  by  physicians  by  simply  weighing  their  patients, 
and  observing  that  the  body  remains  of  the  normal 
weight  with  a  given  diet. 

When  the  body  is  in  this  state  of  i)hysiological 
equilibrium,  about  90  per  cent,  of  all  tlie  carbon  taken 
in  tl  e  food  is  excreted,  in  the  form  of  carbonic  acid, 
by  the  lungs  and  skin,  and  about  10  per  cent,  in  the 
ininary  excreta  and  faices.  Almost  all  the  nitrogen 
of  the  food  is  excreted  in  the  form  of  urea  within 
twenty-foiir  hours.  The  hydrogen  is  eliminated  chiefly 
in  tlie  form  of  water  ;  the  oxygen  chiefly  in  the  form 
of  carbonic  acid  and  water.  Owing  to  the  oxidation 
of  hydrogen,  more  water  is  eliminated  than  is  taken 
in.  The  soluble  salts  are  mostly  discharged  in  the 
urine;  the  insoluble  and  less  soluble  ones  (especially 
those  of  potash)  in  the  fjeces ;  some  pass  off  in  the 
perspii'ation. 

The  sulphur  which  is  contained  in  albumen  is,  in 
part,  excreted  in  the  form  of  urinary  sulphates,  and  in 
part  in  the  fseces  (Taurin),  and  a  small  proportion  by 
the  skin  (epidermal  scales). 


12 


CHAPTER  IL 

TIIR   NUTRITIVE   VALUE   AND    USES    OP   THE    DIFFERENT 
CLASSES    OF   FOOD. 

We  how  pass  on  to  the  consideration  of  the  purposes 
or  uses,  in  the  nutrition  and  maintenance  of  the 
structure  and  functions  of  the  body,  of  the  several 
groups  of  alimentary  substances  set  forth  in  the  last 
chapter. 

As  the  human  body  is  chiefly  composed  of  albu- 
minous or  nitrogenous  substances,  and  as  the  various 
functions  of  the  body  are  mainly  concerned  with  the 
physical  and  chemical  changes  these  undergo,  we  shall 
be  prepared  to  find  that  the  class  of  albuminates,  or 
the  nitrogen-containing  group  of  foods,  plays  a  very 
important  part  in  its  nutrition,  and  in  the  develop- 
ment and  maintenance  of  its  energies. 

'•  The  presence  of  nitrogen  in  an  organised  struc- 
ture, and  its  participation  in  the  actions  going  on 
there,  is  a  necessary  condition  for  the  manifestation 
of  any  energy,  or  any  chemical  change.  .  .  If  the 
nitrogen  be  cut  off  from  the  body,  the  various  func- 
tions languish.  This  does  not  occur  at  once,  for  every 
body  contains  a  store  of  nitrogen,  but  it  is  at  length 
inevitable.  .  .  If  it  is  wished  to  increase  the 
manifestations  of  the  energies  of  the  various  organs, 
more  nitrogen  must  be  supplied ;  .  .  .  without  the 
participation  of  the  nitrogenous  bodies,  no  oxidation 
or  manifestation  of  energy  is  possible."  * 

Liebig's  theory,  which  taught  that  the  functional 
activity  of  the  nitrogenous  tissues  involved  a  pro- 
portionate waste  of  the  structural  elements  of  those 
tissues,  and  necessitated  a  corresponding  consumption 

*  Parkes's  "Hygiene,"  chap,  viii.,  on  Food,  8th  edition.  By 
rrofessor  Nottcr. 


Chap.  II.]  Functions  of  the  Albuminates.  13 

of  nitrogenous  material  to  replace  that  loss,  has  been 
found  incon.sistent  with  later  researches,  and  his  con- 
clusion that  the  class  of  albuminates  or  nitrogenous 
foods  was  solely  applied  to  the  repair  of  the  waste  or 
destruction  of  the  nitrogenous  tissues,  involved  in 
their  functional  activity,  is  no  longer  accepted,  nor 
his  definition  of  this  class  as  exclusively  the  "  plastic  " 
or  "  tissive-forming  "  foods,  in  contradistinction  to  the 
carbohydrates  and  the  fats,  which  he  termed  "  respira- 
tory "  or  "  heat-forming  "  fooJs. 

The  functions  of  the  class  of  albuminates  are  no 
doubt  threefold — 

1st,  They  contribute  to  the  formation  and  repair 
of  the  tissues  and  fluids  of  the  body,  and  in  an  especial 
manner  of  the  nitrogenous  tissues. 

2nd,  They  regulate  the  absorption  and  utilisation 
of  oxygen,  and  so  play  a  very  important  part  in  the 
chemistry  of  nutrition. 

3rd,  Under  special  conditions  they  may  also  con- 
tribute to  the  foimation  of  fat,  and  to  the  develop- 
ment of  muscular  and  nervous  energy,  and  to  the 
production  of  heat. 

We  have  already  pointed  out  how  large  a  part  of 
the  whole  body  the  nitrogenous  tissuea  form,  and  that 
it  is  entirely  through  their  agency  that  all  bodily 
energy  is  developed ;  the  active  principles  in  the 
various  secretions  of  the  body  are  also  nitrogenous ; 
the  development  and  maintenance  of  thase  tissues  and 
secretions  are,  therefore,  the  jrriniary  functions  of  the 
class  of  albuminates. 

It  has,  however,  been  proved  that  the  elimination 
of  ui-ea  in  the  urine  is  closely  proportioned  to  the 
amount  of  the  nitrogenous  ingesta,  and  it  is  therefore 
certain  that  the  nitrogenous  alimentary  principle* 
must  undergo  such  chemical  changes  in  the  system  as 
result  finally  in  the  production  of  urea.  They  must 
therefore  play  an  important  part  in  the  "  absorption 
and  utilisation  "  of  oxygen  in  the  system. 

It  has,  in  the  third  place,  been  experimentally 
established  that  fat  may  be  formed  at  the  expense  of 


14  Food  in  Health.  [Pani, 

albuminates;  "so  that  the  nitrogenous  substance 
plays  two  parts  :  1  st,  that  of  the  organic  framework, 
i.e.  of  the  regulator  of  oxidation  and  of  transformation 
of  energy;  and  2nd,  it  may  form  a  non-nitrogenous 
substance  which  is  oxidised  and  transformed."  * 

Voithas  pointed  out  that  the  albumen  in  the  body 
exists  in  two  conditions  :  1  st,  that  which  is  organised, 
and  which  forms  part  of  the  tissues,  and  which  may, 
therefore,  be  termed  "  organic  albumen ; "  and  2n(l, 
that  which  exists  in  the  fluids,  permeating  all  the 
tissues,  and  which  may  bo  called  "  circulating  albu- 
men." The  former  is  relatively  stable,  but  the  latter 
undergoes  rapid  changes  in  the  processes  of  functional 
activity  :  whereas,  according  to  Voit,  70  per  cent,  of 
the  latter  is  used  up  in  twenty -four  hours,  only  1  per 
cent,  of  the  former  is  consumed. 

It  is  now  generally  admitted  that,  in  ordinary 
conditions,  only  a  small  amount  of  the  "  organic  albu- 
men "  undergoes  decomposition,  and  that  metabolism 
of  the  nitrogenous  tissues  is  but  sliijhtly  influenced  by 
the  activity  of  the  organism.  On  tlie  other  hand,  tlie 
"  circulating  albumen "  under  the  influence  of  the 
cellular  elements  of  the  tissues  undergoes  transforma- 
tion to  a  considerable  extent,  such  transformation 
probably  taking  the  form  of  a  splitting-up  of  its  con- 
stituent elements  into  nitrogenous  waste  substances 
such  as  creatin,  uric  acid,  and  especially  urea,  which 
are  rapidly  eliminated,  and  non-nitrogenous  sub- 
stances, some  of  which  may  be  deposited  in  the  tissue  i 
in  the  form  of  fat,  and  some  may  be  consumed  and 
oxidised  in  the  production  of  heat  and  functional 
energy. 

It  is  quite  true,  however,  that  in  certain  patho- 
logical conditions,  and  especially  in  febrile  maladies, 
the  "  organic  albumen  "  becomes  less  stable,  and  may 
then  undergo  rapid  changes,  attended  by  notable  waste 
of  tissue  and  emaciation. 

It  is  certain  that  the  functional  activity  of  the 
organism  is  greatly  dependent  on  the  presence  of 
*  Parkes's  '•  Hygiene,"  ch.ap.  viii.,  on  Fool. 


Chap.  II.]    FUAXT/ONS   OF    THE   ALBUMINATES.  1 5 

albuminates  in  tlie  food  ;  and  no  other  class  of  ali- 
mentary substances  can  adequately  re|)lace  albumen 
in  sustaining  the  vital  processes.  Albumen  exerts 
the  greatest  influence  on  the  energy  of  the  metabolic 
processes,  since  it  easily  undergoes  a  splitting-up  in 
the  nutrient  fluids,  and  at  the  same  time  eunbles  the 
living  cells  to  break  up  other  matters  in  larger 
quantities. 

Albumen  (together  with  water  and  salts)  is  able 
alone  to  support  the  vital  processes,  and  it  is  the  only 
alimentary  substance  that  can  do  so.  If  can,  there- 
fore, replace  in  nutrition  the  fats  and  carbohydrates, 
but,  when  taken  exclusively,  it  is  very  unsuitable  diet, 
as  the  amount  thus  requu'ed  to  maintain  the  constitu- 
tion of  the  body  is  disprojiortionate  and  wasteful. 

As  has  already  been  said,  it  is  now  generally 
admitted  that  fat  can  be  formed  from  albuminates. 
Pettenkofer  and  Voit  concluded  from  their  experi- 
ments that  albumen  is  split  up  in  the  body  into  a 
niti'ogonous  and  a  non-nitrogenous  part,  the  latter 
having  nearly  the  same  composition  as  fat ;  this  may 
be  either  stored  up  in  the  organism  or  further  trans- 
formed into  carbonic  acid  and  water ;  aiul  HenneWrg 
states  that  100  granunes  of  albumen  split  up  into 
3.3-5  grammes  of  urea  (which  carries  ofl"  all  the  nitro- 
gen) and  60  5  grammes  of  non-nitrogenous  matter, 
which  combine  with  123  granunes  of  water,  and  after 
the  elimination  of  27  4  grammes  of  carbonic  acid, 
yield  51-39  grammes  of  fat.* 

Lawes'  and  Gilbert's  experiments  on  the  fattening 
of  pigs  ap[)eareil  to  show  that  two-thirds  of  the  total  fat 
stored  up  must  have  originated  in  other  sources  than 
the  fat  taken  in  the  food.  It  would  .seem,  also,  that 
even  glycogen  and  sugar  can  be  formed  from  albu- 
minous substances,  for  glycogen  has  Iwen  found  in  the 
liver  of  animals  fed  exclusively  on  albumen  and  tibrin,t 
and  in  certain  forms  of  diabetes  the  sugar  must  be 

*  Bauer,    "Dietary  of   the  Sick,"  p.    1~.      Von   Ziemssen's 
"Hanilbookof  General  Therapeutics." 

t  G.  See,  "Du  lU^gime  Alimeutairc,'  p.  13. 


i6  Food  in  Health.  [Parti. 

derived  "either  from  proteids  or  fat,  most  probably 
the  former."  * 

In  the  pathological  condition  known  as  fatty  de- 
generation, the  fat  deposited  in  the  tissues  appears  to 
be  formed  at  the  expense,  and  by  the  splitting  up,  of 
the  "  organic  albumen." 

The  functions  of  the  class  of  albuminates  may  now 
be  thus  briefly  recapitulated  : — (1)  They  are  the  essen- 
tial agents  by  which  the  nitrogenous  organised  tissues 
are  developed  and  repaired,  as  well  as  all  the  other 
nitrogenous  substances  in  the  fluids  and  secretions  of 
the  body ;  (2)  They  stimulate  functional  activity, 
and  promote  oxidation  and  metabolism  in  the  body  ; 
(3)  They  are  capable  of  splitting-up  in  the  organism 
into  a  nitrogenous  and  a  non-nitrogenous  part,  and 
from  the  latter  fat  may  be  formed  and  deposited  in 
the  tissues  or  consumed  in  the  production  of  force. 

Before  passing  on  to  the  consideration  of  the  food- 
value  of  the  other  classes  of  alimentary  substances,  it 
will  be  well  to  state  what  has  been  determined  as  to 
the  utility  in  nutrition  of  the  gelatigenous  substances, 
as  these  are  also  nitrogenous,  and  are  even  richer  in 
nitrogen  than  the  albuminates. 

It  has  been  long  known  that  gelatin  cannot  replace 
the  albuminates  in  the  repair  and  maintenance  of  the 
tissues,  as  it  undergoes  rapid  and  complete  metabolism 
within  the  body,  being  eliminated  chiefly  in  the  form 
of  urea.  It  is,  therefore,  of  no  direct  value  as  a 
"  plastic  "  food.  It  must  not,  however,  be  hastily 
concluded,  as  was  at  one  time  done,  that  gelatin  is  on 
that  account  worthless,  and  that  it  answers  no  nutri- 
tive purpose.  The  very  rapidity  and  ease  with  which 
gelatin  undergoes  decomposition  within  the  body  give 
it  a  value  as  a  substitute,  in  a  certain  sense,  for  albu- 
minates, the  metabolism  of  which  it  diminishes.  It 
is,  therefore,  an  albumen-sparing  food,  and,  except 
for  the  purposes  of  building-up  and  repairing  the 
tissues,  can  suitably,  and  to  a  certain  limited  extent, 
take  the  place  of  albuminates  in  nutrition.  "  By  the 
•  Parkes's  "  Hygiene,"  8th  edition,  p.  244. 


Chap.  II.]   Functions  OF  tjie  Hydrocarbons.       17 

administration  of  gelatin  very  large  quantities  of 
albumen  can  be  spared  in  the  body,  or  devoted  to 
increase  of  bulk."     (Bauer.) 

Gelatin  has  been  observed  to  induce  a  slight  dimi- 
nution also  ill  the  metabolism  of  the  non-nitrogenous 
substances  in  the  body.  Owing  to  the  larger  propor- 
tion of  nitrogen  that  enters  into  its  com})Osition, 
gelatin,  when  introduced  into  the  body,  leads  to  a 
greater  elimination  of  urea  than  albumen,  and  this 
excessive  excretion  of  urea  induces  increased  diuresis 
and  consequent  thirst  and  demand  for  fluid,  if  large 
quantities  are  consumed. 

Schift*  has  stated  that  gelatigenous  substances 
promote  the  secretion  of  the  gastric  juice,  and  there- 
fore belong  to  the  group  of  peptogenic  foods. 

It  may  be  accepted  as  a  practical  conclusion  that 
gelatin  is  useful  as  an  "  albumen-sparing  "  food,  and 
that  alimentary  substances  containing  it  tend  to  pre- 
vent the  destruction  of  albuminates  and  fats.  It  is 
especially  appropriate  to  those  febrile  states  in  which 
the  stability  of  the  "organic  albumen"  is  threatened, 
and  at  the  same  time  the  capacity  of  assimilating 
albuminous  food  is  greatly  diminished. 

In  the  next  place  we  must  consider  tlie  purposes 
scj'ved  by  the  class  oifats  or  hydrocarbons  in  nutri- 
tion. Liebig's  views  with  regard  to  this  subject  also 
have  been  shown  to  be  erroneous.  He  considered  the 
function  of  fats  to  be  entirely  respiratory,  and  that  by 
combining  with  oxygen,  admitted  into  the  system  in 
respiration,  they  were  consumed  in  the  production  of 
heat,  and  that  the  completeness  of  this  combustion 
depended  on  the  amount  of  inspired  oxygen.  But  it 
has  been  observed  that  when  an  exclusive  diet  of  fat 
has  been  taken,  there  has  been  less  fat  metabolised 
and  less  oxygen  absorbed  than  in  fasting,  and  also 
tha*",  in  certain  circumstances,  the  whole  of  the  albu- 
men in  the  food  is  metabolised  in  the  body,  and  the  fat 
is  appropriated  to  increase  the  body-weight ;  an  inver- 
sion of  the  formerly  assumed  roles  of  hydrocarbona 
C 


.i8  Food  in  Health.  iPani. 

and  albuminates.  From  which  it  would  appeiir  that, 
under  certain  conditions,  fat  is  split  up  into  simpler 
bodies  with  greater  difficulty  than  albumen,  and 
must  not,  therefore,  be  regarded  as  the  same  easily 
combustible  substance  in  the  organism  that  it  is 
outside. 

It  is  not,  then,  through  the  direct  action  of  oxygen 
that  the  non-nitrogenous  foods  any  more  than  the 
nitrogenous  ones  are  split  up  into  simpler  products, 
but  by  the  agency  of  the  cellular  tissues,  and  the 
oxygen  enters  into  these  products  "  little  by  little." 
Indeed,  under  the  influence  of  fat  tissue- waste  is 
lessened,  and,  therefore,  less  oxygen  is  taken  into 
the  system  ;  less  oxygen  being  abstracted  from  the 
blood  by  the  products  of  metabolism. 

We  thus  see  that  one  of  the  great  purposes  served 
by  fat  in  the  food  is  to  diminish  albuminous  metabo- 
lism, and  it  is,  therefore,  regarded  as  an  "  albumen- 
sparing"  food.  "If  flesh  alone  be  given,  large  quan- 
tities are  required  in  order  that  nutrition  and  waste 
may  balance  one  another,  but  if  fat  be  added  the 
demand  for  flesh  is  less."     (Bauer.) 

But  the  fats  have  also  an  important  relation  in  the 
body  to  the  production  of  force  and  heat,  to  body-work 
and  body-temperature.  While,  unlike  the  albuminates, 
the  metabolism  of  hydrocarbons  is  independent  of  the 
amount  taken  in  as  food,  it  is  notably  affected  by 
bodily  exercise,  which  produces  little  effect  on  nitro- 
genous metabolism.  The  fats,  therefore,  undoubtedly 
miiuster  to  force-production,  and  undergo  destruction 
and  oxidation  in  the  process ;  so  that  the  amount  of 
carbonic  acid  given  off" during  exercise  is  much  greater 
than  during  rest. 

External  temperature  also  influences  the  meta- 
bolism of  the  hydrocarbons,  and  therefore  the  amount 
of  carbonic  acid  excreted  ;  the  lower  the  temperature, 
so  long  as  that  of  the  body  itself  is  maintained,  the 
greater  the  metabolism  of  non-nitrogenous  foods,  and 
the  greater  the  amount  of  carbonic  acid  discharged 
from  the  body.     This  is  one  of  the  chief  means  of 


Chap.  II.]     Functions  of  the  Hydrocarbons.       19 

regulating  the  temperature  of  the  body,  and  keeping 
it  constant. 

When,  liowever,  the  temperature  of  the  body  itself 
is  disturbed,  as  in  fever,  then  the  higher  the  tempera- 
ture the  greater  the  waste  of  the  non-nitrogenous,  as 
well  as  of  the  nitrogenous,  constituents  of  the  body, 
and  the  greater  the  excretion  of  carbonic  acid,  as  well 
as  of  urea. 

Tt  is  probably  through  the  nervous  system  that  the 
exteiThil  temperature  influences  the  metabolic  processes 
in  the  body,  and  especially  through  the  peripheral 
sensory  nerves. 

It  would  appear  that  albuminates  and  fats  are,  to 
a  certain  ex.tent,  opposed  to  one  another  in  their 
action  on  the  organism,  as  the  former  increase  waste 
and  promote  oxidation,  while  the  latter  have  the 
effect  of  diminishing  them,  and  this  they  do  pro- 
bably by  affecting  the  metabolic  activity  of  the  cells 
of  the  tissues  themselves.  It  is  a  matter  of  common 
observation  that  fat  animals  bear  privation  of  food 
better  than  thin  ones  ;  in  the  latter,  their  small  store 
of  fat  is  quickly  consumed,  and  then  the  albumen  is 
rajiidlv  decomposed.  It  is  for  the  same  reason  that 
corpulent  persons,  even  on  a  very  moderate  amount  of 
food,  are  apt  to  become  still  more  corpulent. 

The  influence  of  fat  in  the  storage  of  albumen  is 
exemplified  by  the  fact  that  if  1,500  grammes  of  lean 
meat  be  given  alone,  it  will  be  wholly  decomposed  ; 
hut  if  100  to  150  grammes  of  fat  be  added,  then  it 
will  yield  only  1,422  grammes  of  waste.  It  has  also 
been  shown  that  the  balance  of  income  and  expendi- 
ture of  albuminates,  although  the  amount  taken  in  the 
food  may  be  very  small,  is  readily  established  as  soon 
as  one  adds  a  certain  quantity  of  fat.  A  dog  who 
took  daily  1,200  grammes  of  lean  meat  was  observed 
to  be  still  losing  some  of  the  albutninous  constituents 
of  the  body  ;  whereas,  with  only  500  granmies  of  flesh 
and  200  grammes  of  fat,  the  nutritive  balance  was 
rapidly  re-established.  The  same  has  been  observed 
in  man.  Rubncr  found  that  an  individual  taking 
c  2 


20  Food  in  Health.  [Pani. 

daily  1,435  grammes  of  meat,  containing  48*8  grammes 
of  nitrogen,  lost  by  the  kidneys  50  8  grammes  of 
nitrogen ;  whereas  another  taking  meat  and  bread 
containing  23 "5  grammes  of  nitrogen,  to  which  were 
added  191  grammes  of  fat,  only  eliminated  19  grammes 
of  nitrogen  on  the  second  day  of  the  diet ;  *  so  that 
a  small  quantity  of  albumen,  when  combined  with 
fat,  is  sufficient  to  maintain  the  albuminous  structures 
of  the  body.  As  a  practical  conclusion  from  these 
considerations,  we  should  note,  that  if  we  wish  to 
increase  the  weight  of  the  body  and  add  to  its  con- 
stituents, we  must  not  rely  on  an  excess  of  albu- 
minates, as  these  given  alone  only  lead  to  increased 
waste  ;  but  if  we  combine  fats  with  albuminates  in 
proper  proportions,  an  appreciable  increase  of  both 
the  nitrogenous  and  non-nitrogenous  constituents 
of  the  body  can  be  maintained  for  a  considerable 
time. 

We  see,  then,  how  a  proper  use  of  fat  economises 
the  albuminous  elements  of  food  and  checks  the  waste 
of  the  albuminous  tissues.  Fat  enters  into  all  the 
tissues.  By  its  decomposition  and  oxidation  it  yields 
muscular  force  and  heat,  and  it  is  therefore  largely 
consumed  in  muscular  exercise.  By  its  capacity  of 
being  stored  up  in  the  body  as  adipose  tissue,  it 
provides  a  reserve  store  of  force-producing  and  heat- 
generating  material  which  can  be  utilised  as  required. 

The  supporting  influence  of  fat  under  great 
muscular  fatigue  is  strongly  maintained  by  Ebstein : 
and  it  is  stated  that  the  German  Emperor,  in  the 
war  of  1870,  recognised  this  fact  by  requirmg  that 
each  soldier  should  have  served  out  to  him  daily 
250  grammes  of  fat  bacon  ! 

As  (jlycerin  is  derived  from  fats,  it  was  thought  it 
might  possess  the  same  albumen-sparing  functions, 
but  experiment  li.Ts  shown  that  this  is  not  the  case ; 
on  the  contrary,  it  raise.s  the  amount  of  albuminous 
waste,  and  increases  the  flow  of  urine,  in  which  it 
is  eliminated  in  large  proportion. 

*  Germain  S<Se,  "Du  R«5gimc  Aliinentairc." 


Chap.  II.]    Functions  of  the  Carbohydrates.     21 

The  class  of  carbohydrates  have  much  in  common 
with  the  fats.  They  serve  the  same  purpose  of 
checking  albuminous  waste ;  like  them,  they  are  re- 
solved T»y  combustion  within  the  body,  ultimately, 
into  carbonic  acid  and  water,  and  so,  like  the  fats, 
are  capable  of  yielding  heat  and  mechanical  work. 
Unlike  the  fats  and  the  albuminates,  however,  they 
do  not  appear  to  enter  into  the  structure  of  the 
tissues,  although  they  are  found  in  some  of  the  fluids 
and  organs  of  the  body. 

All  the  carbohydrates  are  converted  into  glucose, 
or  grape  sugar  (or  maltose),  before  they  are  absorbed, 
and  in  this  form  they  are  much  more  readily  meta- 
bolised than  the  fats  or  albuminates. 

It  is  believed  by  many,  and  the  weight  of  evidence, 
a.s  will  be  seen,  is  in  favour  of  the  conclusion,  that 
(;arbohydrates  can  be  converted  into  fat  within  the 
organism.  Bauer,*  however,  is  indisposed  to  accept 
this  view.  Basing  his  opinions  on  the  experiments 
of  Pettenkofer  and  Voit,  who  showed  that  carbo- 
hydrates, even  when  administered  in  great  excess, 
are  almost  completely  destroyed  within  the  body, 
he  maintains  that  although  the  carbohydrates,  when 
given  together  with  albumen  and  fat,  favour  an  in- 
crease of  the  constituents  of  the  body,  and  especially 
of  fat,  yet  it  is  not  because  they  are  themselves 
converted  into  fat,  but  because,  owing  to  the  facility 
with  which  they  are  metabolised,  they  protect  the 
other  food-stuffs  from  destruction. 

"  When  fat  and  carbohydrates  co-exist  in  the 
food,  the  latter  ai'e  always  the  first  to  be  consumed ; 
and  when  they  are  present  in  sufficient  amount,  the 
consumption  of  fat  in  the  body  may  be  completely 
suspended."  And  he  explains  in  a  similar  manner 
the  fact  that  a  deposit  of  fat  may  be  observed  to 
take  place  when  the  diet  consists  of  albuminates 
and  carbohydi'ates  alone,  without  any  fat;  for  in 
that  case,  he  says,  the  fat,  which  "  originates  as  a 
product  of  the  splitting-up  of  albumen,  is  withdrawn 
*  "Dietary  of  the  Sick  :  Value  of  Food  Stuffs,"  p.  32. 


2  2  Food  in  Health.  [Pani. 

from  further  metabolism  in  favour  of  the  carbo- 
hydrates, and  contributes  to  the  gain."  He  also 
rejects  the  view  that  the  ready  decomposition  of  the 
carbohydrates  in  the  body  depends  on  their  great 
affinity  for  oxygen ;  he  considers  it  lies  rather  in  the 
properties  of  the  animal  tissues,  and  he  points  out 
that  the  assumed  equivalents  of  starch  and  fat,  as  240 
of  the  former  to  100  of  the  latter,  calculated  on  the 
quantity  of  oxygen  required  for  their  combustion,  are 
incorrect;  and  that  in  the  living  organisms  "175 
parts  of  starch  are  in  the  material  actions  approxi- 
mately equivalent  to  100  of  fat." 

Germain  S^e  begins  by  supporting  the  view  taken 
by  Bauer,  and  asserts  that  the  principal  function  of 
the  carbohydrates  is  the  immediate  development  of 
heat  and  mechanical  work  ;  that  they  are  not  an- 
nexed in  any  way  directly  or  indirectly  to  the  organ- 
isms ;  and  that  the  fat  that  is  deposited  in  consequence 
of  their  use  is  derived  from  the  splitting-up  of  albu- 
minates. He  urges  the  experiments  of  Boussingault, 
who  found  that  when  he  fed  ducks  on  a  pure  carbo- 
hydrate like  rice,  they  grew  thin ;  but  on  adding  a 
small  quantity  of  butter,  they  grew  fat.  The  same 
experimenter  also  asserted  that  milch-cows  only  gave 
out  the  quantity  of  fat  in  their  milk  that  was  con- 
tained in  their  food.*  See  also  points  out  that  the 
particular  kinds  of  grain  selected  for  fattening  animals 
are  always  such  as  contain,  like  maize,  a  considerable 
quantity  of  fat.  But,  notwithstanding  all  this,  he 
appears  in  the  end  to  yield  to  the  weight  of  evidence 
that  fat  may  be,  under  certain  circumstances,  formed 
from  carbohydrates. 

Dujardin-Beaunietzf  believes  in  the  possibility  of 
the  transformation  of  glucose,  the  product  of  the 
digestion  of  carbo-hydrates,  into  fat.  He  sees  a  great 
analogy  between  the  formula  for  glucose,  CjjH,.,Og,  and 
that  of  glycerine,  C.^HgO^,  and  thinks  that  the  latter 

*  The  accuracy   of  BoussingauL's   conclusions  was  called  in 
quotion  by  l.it-b'g. 

t  ''  LUygiciie  Alimentaiie." 


Chap.  11.)     fUNCTIOyS   OF    THE    CARBOHYDRATES.        23 

may  result  from  the  splitting  up  of  the  former  with 
the  axidition  of  hydrogen.  He  also  shares,  to  a  certain 
extent,  Pavy's  views,  and  considers  that  a  portion  of 
the  glucose  derived  from  the  digestion  of  carbo- 
hydrates is  deposited  as  "  hepatic  glycogen  "  in  the 
liver,  and  thus  furnishes  the  glucose  necessaiy  to  the 
organism  when  the  food  does  not  contain  any  carbo- 
hydrates, Pavy  maintains,  as  is  well  known,  that 
saccharine  matter,  when  absorbed,  "  on  reaching  the 
liver  is  transformed  by  that  organ  into  amyloid  sub- 
stance [glycogen],  which  is  stored  up  in  its  cells  for 
subsequent  further  change  preliminary  to  being  ap- 
propriated to  the  purposes  of  life."  The  occurrence  of 
this  "  amyloid  substance "  in  the  liver,  even  when  a 
purely  animal  diet  has  been  taken,  he  accounts  for  by 
the  supposition  that  the  liver  is  the  organ  in  which 
the  splitting-up  of  the  albuminates  into  urea  and  a 
non-nitrogenous  substance  occurs,  and  that  the  latter 
is  metamorphosed  by  the  liver  into  "  glycogen."  Pavy 
believes  that  carbohydrates  are  fu'st  converted  into 
this  "  amyloid  substance,"  and  that  this  is  afterwards 
converted  into  fat.  But  he  points  out  what  is  doubt- 
less a  most  important  condition  in  the  convei'sion  of 
carbohydrates  into  fat,  namely,  "  the  co-operation  of 
nitrogenous  in  conjunction  with  saline  matter,"  for  it 
is  probably  by  the  changes  occurring  during  the  meta- 
bolism of  the  albuminates  that  this  transformation  is 
excited.  The  presence  of  a  small  amount  of  fat  with 
the  carbohydrates  would  seem  also  to  favour  this 
conversion,  for  the  rapid  deposition  of  fat  which  some- 
times occurs  when  animals  are  fed  on  such  a  mixture 
appears  to  be  more  than  can  be  accounted  for  by  the 
small  quantities  of  fat  ingested.  Pavy  dops  not  admit 
that  any  of  the  carbohydrates  undergo  direct  oxida- 
tion in  the  system,  or  contribute  flirpctly  to  force 
production. 

In  connection  with  this  interesting  and  important 
discussion,  the  following  observations  by  Tsclierwinsky 
arc  referred  to  in  Landois'  "Tcxt-lwok  of  Human 
Physiology."     He   "  fed    two  similar   pigs  from    the 


34  Food  in  Healtil  \yxt\.\. 

same  litter.  No.  1  weighed  7,300  grammes ;  No.  2 
7,290  grammes.  No.  1  was  killed,  and  its  fat  and 
protcids  estimated.  No.  2  was  fed  for  four  months  on 
grain,  and  then  killed.  The  grain  and  excreta  and 
the  undigested  fat  and  proteids  were  analysed,  so  that 
the  amount  of  fat  and  proteids  absorbed  in  four  months 
was  estimated.  The  pig  then  weighed  24  kilos. ;  11 
was  killed,  and  its  fat  and  proteids  were  estimated  : — 

No.  II.  contained  2"o0  kilos,  of  al1)umcn  and  9-2o  kilos,  of  fat 
No.  I.  „         0-94     „  „  0-69     „ 

Assimilated  l'o6     „  „  8'5G     „  „ 

Taken  in  in  Food  7-49     „  „  0-G6     „  „ 

Difference  —  o-93     „  „  +790     „  „ 

There  were  therefore  7*90  kilos,  of  fat  in  the  Ijody 
which  could  not  be  accounted  for  in  the  fat  of  the 
food.  The  5*93  kilos,  of  albumen  of  the  food  which 
were  not  assimilated  us  albumen  could  3'ield  only  a 
small  part  of  the  7*90  kilos,  of  fat,  so  that  at  least 
5  kilos,  of  fat  must  have  been  formed  from  carlx)- 
hydrates.  Lawes  and  Gilfcfert  calculated  that  40  per 
cent,  of  the  fat  in-  'pigs  was  derived  from  carbo- 
hydrates. How  the  carbohydrates  ai'e  changed  into 
fat  in  the  body  is  entirely  unknown." 

As  has  already  been  stated,  the  weight  of  evidence 
appears  to  be  distinctly  in  favour  of  the  conclusion 
that,  in  some  way  or  other,  the  carbohydrates  are 
capable  of  being  converted  into  fat  in  the  system  ;  but, 
in  any  case,  the  same  result  occurs,  and  they  promote, 
either  directly  or  indirectly,  the  deposition  of  fat 
within  the  body. 

The  probability  that  lactic  and  other  acids  of  the 
same  class  are  formed  in  the  body,  chiefly  or  solely 
from  carbohydrates,  is  drawn  attention  to  by  Parkes.* 
"The  formation  of  these  acids  is  certainly  most  impor- 
tant in  nutrition,  for  the  v.arious  reactions  of  the  fluids, 
which  offer  so  striking  a  contrast  (the  alkalinity  of  the 
blood,  the  acidity  of  most  mucous  secretions,  of  the 

*  "Hygiene,"'  8th  edition,  )).  244. 


Chap.  II.]  Functions  of  Mineral  Substances.     25 

sweat,  urine,  etc.),  must  be  chiefly  owing  to  the  action, 
of  lactic  acid  on  the  phosphates  or  the  chlorides,  and 
to  the  ease  with  which  it  is  oxidised  and  removed." 

We  may  conclude,  then,  that  the  carboliydrates 
by  their  capacity  for  rapid  metabolism  contribute 
largely  to  the  production  of  heat  and  mechanical 
work,  find  also  that  their  use  greatly  favours  an  in- 
crease in  the  constituents  of  the  body,  and  especially 
of  the  albumen  and  fat.  If  we  desire  to  increase  the 
albumen  without  adding  greatly  to  the  store  of  fat,  we 
should  (according  to  Bauer)  give  a  liberal  allowance 
of  albuminates  with  relatively  small  quantities  of 
carbohydrates.  But  if  we  desire  a  substantial  addi- 
tion to  the  fat,  the  food  should  contain  less  albumen 
and  more  carbohydrates,  with  a  fair  proportion  of 
fats. 

Our  fourth  class  of  foods  (romprised  mineral  sub- 
stances and  water.  These  are  of  great  importance, 
and  are  as  essential  to  nutrition  as  the  albuminates. 
There  is  no  tissue  that  does  not  contain  lime,  chiefly 
in  the  form  of  phosphate,  and  it  would  seem  that  cell 
growth  cannot  go  on  without  it ;  indeed,  calcium 
pho.sphate  is  the  most  abundant  salt  in  the  body, 
forming  move  than  one-half  our  bones.  Calcium 
carbonate  occurs  associated  witli  this  phosphate, 
but  in  relatively  much  smaller  quantity.  Sodium 
chloride  is  also  a  very  important  salt,  and  occurs 
in  all  the  tissues  and  fluids  of  tlie  body.  It  plays 
a  very  important  rule  in  promoting  tlie  difiiision 
of  fluids  through  membranes,  and  its  ])resence  is 
necessary  for  maintaining  the  globulins  in  solution. 
It  is  absolutely  necessary  to  existence,  and  its 
entire  withdrawal  from  food  would  be  speedily 
fatal.*  Rather  more  than  200  grains  are  excreted 
daily,  chiefly  in  the  urine.  It  is  a  matter  of  common 
experience  in  the  feeding  of  cattle  that  the  addition 
of  common  salt  to  their  food  greatly  improves  their 

*  "Deprival  of  common  salt  causes  a/6Hmi« uriV(."—Lan<bis' 
"Physiolo-y." 


26  Food  in  Health.  iPani. 

condition.  The  phosphates  of  sodium  and  potassium 
ai'e  also  important  salts.  The  alkaline  reaction  of  the 
blood-plasma  and  some  of  the  other  fluids  is  due 
partly  to  these  alkaline  phosphates.  The  acid  sodium 
phosphate  is  the  chief  cause  of  the  acid  reaction  of 
the  urine.  Sodium  carbonate*  and  bicarbonate  are 
also  found  in  the  blood-plasma ;  they  are  ingested  in 
small  quantities  in  the  food,  and  they  are  i)artly 
formed  in  the  body  from  the  decomposition  of  the 
salts  of  the  vegetable  acids.  Tliey  play  an  important 
part  in  the  blood  in  carrying  the  carbonic  acid  from 
the  tissues  to  the  lungs.  Sodium  and  potassium  sul- 
phates occur  only  in  small  quantity  in  the  body,  and 
are  partly  derived  from  the  oxidation  of  organic 
substances  containing  sulpliur.  Potassium  chloride 
is  widely  distributed,  and  is  found  especially  in  the 
coloured  blood  corpuscles  and  in  muscular  tissue. 
Magnesium  phosphate  occurs  together  with  calcium 
phosphate,  but  in  niucli  smaller  amount ;  it  is  probably 
essential  to  the  growth  of  some  tissues.  Iron  is  an 
essential  constituent  of  hisemoglobin,  and  therefore 
of  the  red  blood  corpuscles ;  it  is  found,  also,  in 
striped  muscle  and  in  other  tissues  in  niinute  quantity. 
The  two  alkalies,  potash  and  soda,  have  a  ditlerent 
dis*:ribution  in  the  body,  and  cannot  replace  one 
another.  The  potassium  salts  exist  especially  in  the 
formed  ti.ssues,  as  the  blood  corpuscles  and  muscular 
fibre  ;  and  the  sodium  salts  are  found  more  abundantly 
in  the  interstitial  fluids ;  so  in  the  blood,  sodium  .and 
the  chlorides  are  found  especially  in  the  plasma,  and 
potassium  and  phosphates  in  the  corpuscle-s. 

The  chlorine  of  the  chlorides  would  appear  to  be 
easily  set  free  in  the  body,  so  that  it  can  combine 
with  hydrogen  and  form  a  powerful  acid,  having  a 
special  solvent  action  on  albuminates.  The  sulphur 
and  phosphorus  of  the  tissue.s  appear  to  be  introduced, 
as  such,  in  the  albuminates. 

*  "  Tlie  alkaline  salts  serVe  to  nctitralise  tho  siilnhuric  aci<l 
formed  by  the  oxid.'\tion  of  the  sulphur  of  the  proteids.  — Tiaiidoia' 
"Physiology."  * 


Chap.  II.]  Functions  of  Mineral  Substances.     27 

All  these  mineral  substances  are  introduced  into 
the  body  as  constituent  parts  of  the  various  ordinary 
articles  of  human  food,  animal  and  vegetable,  with  the 
exception  of  sodium  chloride,  which  is  usually  added 
to  various  articles  of  food,  in  greater  or  less  amount, 
in  addition  to  what  they  may  themselves  contain. 

Certain  salts,  such  as  the  lactates,  tartrates,  cit- 
rates, and  acetates,  become  converted  into  carbonates 
within  the  body,  and  confer  upon  the  system  that 
alkalinity  which  appears  to  be  necessary  to  the  integ- 
rity of  the  molecular  currents.  "The  state  of  mal- 
nutrition, which  in  its  highest  degree  we  call  scurvy, 
appears  to  follow  inevitably  on  their  absence  ;  and  as 
they  exist  chiefly  in  fresh  vegetables,  it  is  a  well- 
known  rule  of  dietetics  to  supply  these  with  gi'eat 
care,  though  their  nutritive  power  otherwise  is 
small."* 

Rabuteau  observed  that  the  addition  of  150  grains 
of  sodium  chloride  to  the  daily  rations  increased 
notably  the  amount  of  urea  excreted  ;  it  would  seem, 
therefore,  to  promote  the  metabolism  of  albuminates  ; 
it  acts  probably  simply  by  stimulating  the  digestive 
functions,  and  possibly  increasing  the  acidity  of  the 
gastric  juice.  It  is  itself  almost  wholly  eliminated  in 
the  urine. 

The  utility  of  adding  phosphates  to  food  with  the 
view  of  increasing  its  nutritive  qualities  has  been 
warmly  discussed,  and  it  has  been  pointed  out,  as  a 
proof  of  their  inutility,  that  the  soluble  phosphates, 
so  given,  are  eliminate  I  in  their  totality  in  the  urine, 
and  the  insoluble  ones  in  the  fteces.  But,  as  has  been 
argued  by  Dnjardin-Beaumetz,  the  same  happens  with 
regard  to  cliloride  of  sodium,  and  it  does  not  follow 
because  of  this  that  it  has  no  influence  on  nutrition. 
The  favourable  action  of  the  phosphates,  soluble  or 
insoluble,  which  is  certainly  at  times  observed,  is 
probably  due,  as  he  suggests,  either  to  a  regulating 
action  on  the  functions  of  the  alimentary  tube,  or  to 
the  acid  elements  they  convey  into  the  stomach,  or  to 
•  Tarkes'  "Hygiene,"  8th  edition,  by  Xotter,  p.  245. 


28  Food  in  Health.  iParti. 

some  other  indirect  action*  "  As  a  rule,  we  take  in 
witli  our  food  a  far  larger  quantity  of  salts  than  is 
necessary  for  the  replacement  of  those  of  the 
tissues.  The  excess  is  excreted  with  the  urine,  and 
only  when  an  increase  of  the  body-weight  occurs 
is  any  large  amount  of  salts  retained  in  the  body." 
{Bauer  ^ 

Water  enters  into  the  composition,  in  greater  or 
less  proportion,  of  most  solid  and  all  fluid  foods,  and 
it  is  tlie  essential  basis  of  all  beverages.  It  forms 
58-5  per  cent,  of  the  human  body,  from  which  it  is 
continually  passing  off  by  the  urine  and  ffeces,  and  by 
the  skin  and  lungs.  Water  is  essentially  requisite  in 
the  processes  of  digestion  and  absorption  as  a  solvent 
for  food  substances,  and  it  is  also  required  for  the 
solution  of  the  various  substances  which  have  to  be 
removed  from  the  body  in  the  excretions,  especially 
in  the  urine.  Indeed,  there  is  no  vital  action  possible 
without  water.  The  amount  of  water  needed  by  the 
body  depends  on  various  circumstances,  especially  on 
bodily  temperature  and  bodily  labour.  The  greater 
the  functional  activity  of  the  bodily  organs  the  greater 
the  need  for  water.  The  temperature  and  humidity 
of  the  surrounding  air  also  exercise  an  influence,  as 
well  as  the  nature  and  amount  of  solid  food.  The 
need  of  the  organism  for  water  is  usually  indicated, 
when  in  health,  by  the  sensation  ai  thirst.  An  insuf- 
ficient supply  of  water  leads  to  disturbances  in  the 
circulation,  and  in  the  distribution  of  heat,  and  to  the 
retention  in  the  body  of  the  waste  products  of  meta- 
bolism. The  free  ingestion  of  water  promotes  an 
active  circulation  of  the  fluids,  accelerates  albuminous 
metabolism,  and  increases  the  activity  of  the  kidneys 
;»nd  the  amount  of  urine  secreted.  It  has  been 
asserted  and  denied  by  different  observers  that  an 
increased  consumption  of  water  leads  to  an  increased 
elimination  of  urea,  and  acts,  therefore,  as  an  ac- 
celerator of  nutritive  changes.  The  weight  of  evi- 
dence and  authority  are  in  favour  of  the  affirmative 
view,  but  the  influence  is  only  temporary. 


Chap.  II.]  SrJMULANTS   AND    CONDIMENTS.  29 

The  various  substances  known  as  stimulants  and 
condiments,  although  not  included  in  either  of  the 
preceding  classes,  and  although  they  may  have  no  direct 
nutritive  function,  undoubtedly  exercise  an  important 
indirect  influence  on  the  processes  of  nutrition.  They 
stimulate  appetite,  and  give  relish  to  food,  and  by 
acting  on  the  perii)lieral  nerves,  especially  those  of 
taste  and  smell,  they  promote  the  digestive  secretions 
and  rouse  the  digestive  functions. 

It  has  now  been  seen  that  each  of  these  four 
classes  of  alimentary  substances  has  a  special  value  in 
nutrition,  and  although  the  members  of  one  group 
may  be  competent  to  serve,  to  a  certain  extent,  the 
purposes  of  those  of  another,  yet  in  order  to  accom- 
plish the  best  results  a  combination  of  all  of  them  is 
required.  An  adequate  diet  must  contain  a  mixture 
of  several  articles  of  food,  in  which  all  those  classes 
are  represented  in  due  proportion. 

Some  differences  of  opinion  exist  as  to  the  relative 
value  of  foods  of  the  same  class.  Albuminates,  as  has 
been  seen,  can  be  obtained  from  either  the  animal  or 
vegetable  kingdom ;  they  have  a  similar  chemical  com- 
position, and  they  serve  the  same  purposes  in  the  body. 
It  has,  however,  been  suggested  that  they  are  probably 
utilised  in  a  somewhat  diti'erent  manner,  or  with  dif- 
ferent degrees  of  rapidity,  and  that  the  man  who  feeds 
on  meat,  like  carnivorous  animals,  "  will  be  more 
active,  and  more  able  to  exert  a  sudden  violent  efibrt, 
than  the  vegetarian  or  the  herbivorous  animal,  whose 
food  has  an  equal  potential  energy,  but  which  is  sup- 
l)Osed  to  be  less  easily  evolved."  In  su]iport  of  this 
view  it  has  been  uiged  that  the  movements  of  carniv- 
orous animals,  especially  in  the  pursuit  of  their  pi'ey, 
are  far  more  active  than  those  of  herbivorous  cattle  ; 
that  the  form  in  which  thej'^  take  their  food  enables 
them  to  give  out  sudden  spurts  of  energy  of  which 
the  vegetable  feeder  is  incapable.  But  this  view  has 
been  questioned  by  others,  who  refer  to  the  known 
activity  and  speed  of  the  horse,  the  rapid  movements 


30  Food  in  Health.  (Pani. 

of  the  wild  antelope  and  cow,  and  even  of  the  wild 
pig,  all  animals  mostly  herbivorous,  as  inconsistent 
with  the  conclusion  that  vegetable  feeders  cannot 
give  forth  energy  as  rapidly  and  continuously,  or  even 
more  so,  than  the  predaceous  carnivora.  It  is  further 
stated  that  with  the  human  race  also,  the  East  Indian 
native,  if  well  fed  on  corn,  or  even  on  rice  and  peas, 
shows,  wl)en  in  training,  no  inferiority  in  capacity  for 
active  physical  exertion  to  the  animal  feeder.  It 
has  also  been  argued  that  the  complicated  alimentary 
canal  of  the  herbivora  pointed  to  a  slower  digestion 
and  absorption  of  food  ;  and  with  certain  kinds  of 
vegetable  food  this  would  certainly  seem  to  be  the 
case ;  but  it  has  again  been  contended  that  this  is 
chiefly  intended  for  the  digestion  of  cellulose,  and  that 
the  digestion  and  absorption  of  albuminates  may  be  as 
rapid  as  in  other  animals. 

It  must,  we  think,  be  adoiitted  that  all  practical 
observations  tend  to  prove  that  animal  food  is  digested 
more  rapidly  than  vegetable  food,  and  it  therefore 
setms  highly  probable  that  meat  can  replace  the  waste 
of  the  nitrogenous  tissues  more  rapidly  than  meal  of 
any  kind,  and  it  is  probably  true  that  there  is  a  more 
active  change  of  tissue  in  meat  eaters  than  in  veget- 
able feeders,  and  that  the  former  require  more  fre- 
quent supplies  of  food.  Apparent  ditferences  in 
nutritive  value  in  difl'erent  meals,  as  in  wheatmeal 
and  barleymeal,  probably  depend  on  diflference  of 
digestibility. 

The  diflerence  in  the  nutritive  value  of  different 
fats  would  seem  to  depend  on  the  relative  facility 
with  which  they  are  digested  and  absorbed.  Animal 
fats  appear  to  be  more  easily  absorbed  than  vegetable. 
And  even  diflferent  animal  fats  difier  much  in  digest- 
ibility, and,  therefore,  in  nutritive  value.  This  de- 
pends partly  on  chemical  composition,  and  partly  on 
mechanical  aggregation  or  subdivision.  Mutton-fat 
is  generally  found  difficult  of  digestion,  while  jwrkfat 
is  easily  digested.  Butter  can  be  readily  digested  by 
many  per^tons  who  cannot  digest  other  forms  of  fat  j 


chai..  u.]      C A RBom'DR ATMS  IN  Nutrition.  31 

and  the  ready  digestibility  of  ccxl-liver  oil  is  one  of  its 
chief  advantages. 

The  difierent  carbohydrates  are  generally  supposed 
to  be  of  equal  value  in  nutrition.  Sugar,  from  its 
ready  solubility,  should  be  more  easily  absorbed  and 
more  quickly  utilised  than  starch,  but  it  is  found 
that  when  both  are  procurable  a  mixture  of  the  two 
is  usually  preferred. 

It  will  be  convenient  now  to  pass  in  brief  review 
the 

Okdinary  Articles  of  Food  and  Drink; 

the  vaiious  Alimentary  Substances,  or  "Food-stuffs," 
as  they  are  also  termed. 

Man,  being  an  omnivorous  aniuial,  obtains  his  food 
supplies  from  a  variety  of  soui'ces.  The  various 
substances  connnonly  employed  in  alimentation  will 
therefore  now  be  described,  their  composition,  proper- 
ties, digestibility,  and  nutritive  value.  Those  derived 
from  the  animal  kingdom  will  be  first  treated  of  \ 
tlien  those  derived  from  the  vegetable  kingdom.  Those 
substances  used  as  condiments  will  also  be  considered, 
as  well  as  the  \  arious  beverages  in  common  use. 


32 


CHAPTER  in. 

ANIMAL    FOODS. 

Animal  foods,  by  wliich  is  usually  meant  the  flesh  of 
animals,  have  certain  decided  advantages.  In  the 
first  place,  they  coutaia  the  same  chemical  elements 
as  the  bodies  they  are  destined  to  feed.  They  are 
very  rich  in  albuminous  or  nitrogenous  substances, 
combined  with  a  certain  amount  of  fat ;  they  aj'O 
more  easily  and  completely  digested  and  assimilated 
than  vegetable  foods  ;  they  are  easily  cooked,  and 
develop  agreeable  llavours  in  the  process  ;  and  they 
contain  important  salts  (chiefly  salts  of  potassium)  and 
some  iron. 

Animal  foods  are  therefore  exceedingly  well 
adapted  to  minister  to  the  growth  and  maintenance 
of  the  organic  structure  of  the  body ;  their  disad- 
vantage is  the  absence  of  starch,  so  that  they  are 
not  so  well  adapted  as  non-nitiogenous  substances  for 
the  production  of  force.  When,  however,  there  is  a 
mixture  of  a  considerable  proportion  of  fat  with  the 
muscle  tissue,  this  disadvantage  is  greatly  lessened. 

In  the  flesh  of  all  animals  we  find,  besides  mus- 
cular fibre,  blood-vessels,  nerves,  fibrous  connective 
tissues,  and  a  variable  proportion  of  fat. 

Analysis  of  pure  muscle  shows  it  to  consist,  on  an 
average,  of  76  per  cent  of  water  and  24  per  cent  of 
solids. 

The  albuminates  amount  to  about  20  per  cent  in 
fre.sh  muscle  free  from  fat ;  by  far  the  greater  portion 
of  this  is  in  an  insoluble  form.  The  soluble  albu- 
minates consist  chiefly  of  myosin,  which,  after  death, 
undergoes  spontaneous  coagulation,  and  cooking  causes 
a  further  coagulation ;  the  other  soluble  albuminates 
are  in  small  proportion,  the  chief  in  quantity  being 


Chap.  III.]    Composition  of  Animal  Flesh.  33 

one  identical  with  serum  albumen.  The  colouring 
matter  of  muscle  belongs  to  the  soluble  albumen.  Of 
the  insoluble  albuminates  of  muscle  but  little  is 
known. 

The  analysis  of  rump  of  beef  made  at  Netley  gave 
the  following  results  : — 


Flesh  alone. 

Whole  ration, 

exchisive  of 

Bone. 

Water     ... 

Proteids 

Fat          

Ash         

740 

22-0 

2-2 

1-6 

60-5 

21-5 

9-1 

13 

Total          

99-8 

92-4 

The  loss  of  8  per  cent,  of  total  weight  in  the 
last  column  is  "due  to  tough  gristle  and  fibrous 
tissues  not  amenable  to  the  ordinary  methods  of 
analysis."* 

The  fatter  the  meat  the  less  water  it  con- 
tains, and  the  smaller  is  the  proportion  of  albu- 
minates. 

It  is  well  known  that  soon  after  an  animal's  death 
the  muscles  pass  into  a  state  of  "rigidity,"  known  as 
rigor  mortis.  This  is  due  to  the  spontaneous  coagula- 
tion of  the  myosin  of  the  muscular  fibre.  It  sets  in 
within  a  variable  period  after  death,  ten  minutes  to 
seven  hours,  and  may  last  an  equally  variable  period, 
from  one  to  six  days.  Its  duration  varies  greatly  in 
different  animals.  It  is  not  usual  to  eat  the  flesh  of 
animals  until  this  has  passed  off,  unless,  which  is  rarely 
convenient,  it  can  be  cooked  before  its  onset.  The 
meat  is  more  tender  and  has  a  better  flavour  after  it 
has  disappeared.  Hence  the  practice  of  "hanging" 
meat  before  cookinsr. 


•  Tarkcs's  "  Hygiene,"  8th  edition,  by  Notter,  p.  262. 
D 


34         '  Food  in  Health.  [Pan  i 

Animal  flesh  (UflTers  considerably  in  quantitative 
composition,  in  flavour,  in  digestibility,  and  in  nutri 
tive  qualities,  according  to  a  variety  of  circumstances,  ■ 
such  as  age,  sex,  state  of  nutrition,  part  of  the 
body,  etc.  etc.  Meat  containing  much  fat  is  gener- 
ally less  digestible  and  less  palatable  than  leaner 
varieties. 

The  flesh  of  young  animals  is  less  digestible  than 
that  of  more  mature  ones :  veal  and  lamb  are  less 
digestible  than  beef  and  mutton  ;  and  in  advanced 
age  the  flesh  becomes  tough  and  uneatable.  There  is 
less  flavour,  less  stimulating  properties,  less  nutritive 
value  in  the  tissues  of  young  animals  than  in  mature 
ones,  and  they  contain  more  gelatin.  A  four-  or  five- 
year-old  ox  yields  the  best  beef,  and  a  three-year-old 
sheep  the  best  mutton. 

The  flesh  of  the  female  has  a  finer  grain  and  is 
more  delicate  than  that  of  the  male  ;  while  tliat  of  the 
entire  male,  during  the  breeding  season,  has  a  coarse 
and  unpleasant  flavour.  Removal  of  the  testes  in  tlie 
male  and  the  ovaries  in  the  female  greatly  improves 
their  edible  qualities. 

It  is  usual  in  slaughtering  animals  for  food  to 
allow  the  blood,  before  or  after  death,  to  drain  away 
as  completely  as  possible  ;  although  this  practice  un- 
doubtedly involves  a  loss  of  nutritive  material,  and  is 
therefore  wasteful,  yet  it  is  to  some  extent  justified 
by  the  consideration  that  it  improves  the  appearance 
of  the  meat,  gives  it. delicacy  of  flavour,  and  enables 
it  to  be  kept  longer. 

In  civilised  life  all  the  animals  used  for  food  are 
vegetable  feeders,  and  the  character  of  the  meat  is 
often  affected  in  a  recognisable  manner  lay  the  nature 
of  the  food.  Pastures  containing  fragrant  herbs, 
certain  roots  as  turnip  and  mangold,  and  oil-cake,  will 
each  impart  a  peculiar  character  to  the  flesh. 

Beef.— This  is,  perhaps,  the  most  extensively 
consumed  and  most  nutritious  of  all  animal  foods. 

The  composition  of  the  flesh,  especially  with  regard 
to   f.at.  will  varv  m\\m\\   according  to  the  condition  of 


Chnp.  III.] 


Beef;  Veal. 


35 


tlic  animal  wlicn  killed.     The  following  figures  refer 
to  three  different  examples  of  butcher's  beef: — 


From  very  fat  Ox 

„      moderately  fat  Ox 
.,      lean  Ox  ... 


Water. 


54-76 
72-25 
76-61 


Nitro^nous 
Substances. 


16-93 
21-39 
20-61 


Fat. 


27-23 
519 
1-50 


The  flesh  varies  also  in  quality,  according  to  the 
part  of  the  animal  from  which  it  is  taken.  The  best, 
or  first  quality,  includes  rump,  sirloin,  fore-ribs ;  the 
second,  a  portion  of  shoulder,  buttock,  middle-rib,  etc. ; 
the  third,  flank,  shoulder,  brisket ;  and  the  fourth, 
cheek,  neck,  and  shin. 

The  difference  in  composition  between  different 
parts  of  a  very  fat  ox  is  shown  in  the  following 
table : — 


Neck      

Loin 

Shoulder  

Hind  Quarter,  lean  part 
„  streaky  „ 

Fore  Quarter,  lean      „ 
stroaky  „ 


Water. 


73-5 

63-4 

50-5 

55-01 

47  99 

65  05 

32-49 


Nitrogenoas 
Matters, 


19-5 

18-8 

14-5 

20-81 

15-93 

19-94 

10-87 


Fat. 


Beef  fat  consists  of  glycerides  of  the  fatty  acids  in  the 
proportion  of  3  of  stearic  and  palmitic  to  1  of  oleia 
Its  melting-point  ranges  between  41°  and  50°  C. 

V<'al.  — Veal  has,  in  Great  Britain,  always  had  the 
reputation  of  being  less  digestible  and  less  nutritious 
than  beef  or  mutton.  It  certainly  contains  a  larger 
pro[)ortioii  of  gelatin  tlian  beef.  But  it  is  more  highly 
valued  in  other  countries ;  and  Bauer  maintains  that 
its  fibres  are  tender,  and  that  it  is  better  boine  by 
D  2 


36 


Food  in  Health. 


[Part  I. 


enfeebled  digestive  organs  than  beef.  This  difference 
of  opinion  no  doubt  depends  on  the  different  manner 
in  which  veal  is  killed  and  prepared  in  Britain  and 
on  the  Continent.  In  England  it  is  a  much  paler,  ex- 
sanguine, and  drier  meat  than  on  the  Continent.  It 
is  probably  killed  younger,  and  bled  too  much  before 
killing.  The  following  table  presents  the  composition 
of  different  joints  of  veal : — 


Water. 

Nitro^'eiious 
Matters. 

Fat. 

Lean  Veal       

78-82 

19-76 

0-82 

Fat       „         

72-31 

18-88 

7-41 

Loin     ... 

76-26 

15-12 

7-12 

Eibs      

72-66 

20-57 

5-12 

Shoulder         

76-57 

18-10 

3-62 

Leg      

70-30 

18  •.•!7 

9-25 

Mutton.— Mutton  is  generally  considered  to  be 
more  easy  of  digestion  than  beef.  Its  fibre  is  shorter 
and  more  tender.  It  often,  however,  contains  a  large 
proportion  of  fat,  which  is  harder  than  beef  fat,  as  it 
contains  more  of  the  glyceride  of  stearic  acid,  Such 
fat  mutton  is  unsuited  to  invalids. 

Mutton,  however,  differs  veiy  greatly  in  quality 
and  flavour ;  when  of  best  quality,  it  is  no  doubt  a 
most  excellent  form  of  animal  food. 

The  following  table  (Konig)  gives  the  composition 
of  mutton  : — 


Moderately  fat 
Very  fat 
Hind  Quarter.. 
Breast ... 
Shoulder 


Water. 


75-99 
47-91 
41-97 
41-39 
00-38 


Albumin- 
ates. 


18-11 
14-80 
14-39 
15-45 
14-57 


Fat. 


7-77 
36-39 
43-47 
42-07 
23-62 


Chap.  III.]    Lamb;   Venison;  Pork;  Bacon.         37 

liamb,  like  veal,  is  less  digestible  than  mutton, 
and  is  very  much  richer  in  fat. 

Ycni$>on. — Of  other  ruminants,  only  the  flesh 
of  the  deer  is  consumed  in  Britain.  On  the  Con- 
tinent, the  flesh  of  the  goat  is  also  eaten  ;  it  resembles 
mutton,  but  has  much  less  flavour,  and  is  much  more 
difl5cult  of  digestion.  Venison  from  young  deer  is 
tender,  short-fibred,  dark-coloured  and  highly  i>avoury, 
and  is  very  digestible.  It  is,  however,  rather  too 
stimulating  and  higlily  flavoured  for  delicate  sto-- 
machs. 

The  following  is  the  composition  of  venison  (Von 
Bibra)  : — Water,  74-63 ;  albuminates  (very  little 
gelatin),  19'24  ;  and  fat,  1"3  per  cent. 

Pork. — Pork,  on  account  of  the  large  quantity 
of  fat  it  contains,  is  the  most  difficult  of  meats  to 
digest.  Like  all  fat  meats,  it  contains  proportionately 
less  water.  Its  fat  differs  from  that  of  venison, 
in  consisting  almost  entirely  of  palmitic  and  oleic 
glycerides. 

The  mean  composition  of  fat  pork,  according  to 
Konig,  is:  Water,  47*40;  albunjiLnates,  14'54 ;  fat, 
37-34.  And  of  ^ean  pork :  Water,  72*57  ;  albuminates, 
19-91 ;  fat,  6-81. 

Bacon  is  more  digestible  than  the  fat  of  fresh 
pork.  It  contains  but  a  small  proportion  of  water, 
and  therefore,  weight  for  weight,  is  an  advantageous 
kind  of  food.  Its  popular  use,  like  that  also  of  boiled 
pork,  with  lean  meats  such  as  veal,  chicken,  and 
rabbit,  and  also  with  other  articles  rich  in  nitro- 
genous matter,  as  eggs,  beans,  and  peas,  is  founded 
upon  a  rational  principle,  serving,  as  it  does,  to  estab- 
lish a  proper  proportion  in  the  supply  of  nitrogenous 
and  carbonaceous  material. 

Besides  the  muscular  tissue  and  fat  of  animals, 
some  of  the  viscera,  the  blood,  and  even  the  bones  may 
be  utilised  for  food. 

By  breaking  the  bones  into  small  pieces,  and 
boiling  for  many  hours,  a  nutritious  extract  is  obtaiiaed, 
consisting  chiefly  of  gelatin ;  3  lb.  of  bone  yielding 


38  Food  in  Health.  [Pani. 

about  as  much  carbon  as  1  lb.  of  meat,  and  as  much 
nitrogen  as  7  lb.  of  meat. 

Bones  can  therefore  be  used  advantageously  in 
the  composition  of  soup,  esi)ecially  in  large  public 
institutions. 

The  brain  of  animals  is  of  soft  consistence,  and 
is  no  doubt  nutritious,  but  it  contains  a  large  per- 
centage of  fat,  which  renders  it  difficult  of  digestion 
by  weak  stomachs :  the  tongue  also  is  tender,  but  is 
intimately  permeated  by  fat. 

The  blood  of  the  pig  is  made  into  a  kind  of  food 
known  as  "black  pudding,"  which  contains  also  fat, 
groats,  and  some  flavouring  condiments. 

Bullock^s  blood  has  also,  at  times,  been  pre- 
scribed for  invalids,  on  the  erroneous  belief  that  it  is 
especially  nutritious  and  easy  of  assimilation.  Not 
only  is  it  repulsive  to  the  palate,  but  it  is  probably 
difficult  of  digestion. 

The  liver  of  the  pig,  the  calf,  and  the  lamb  is 
largely  consumed  as  human  food.  Its  richness  and 
closeness  of  texture  render  it  difficult  of  digestion. 
The  composition  of  calf's  liver  has  been  given  as 
water,  72-33;  albuminates,  20*10;  fat,  5'58;  carbo- 
hydrates (amyloid  matter),  0'45;  salines,  1*54. 

Kidneys  are  of  close,  firm  texture,  and  when 
much  cooked  become  very  hard  and  difficult  of  digestion. 
Sheep's  kidneys  contain  about  17  per  cent,  of  albu- 
minates and  2  i)er  cent,  of  fat. 

The  muscle  of  the  heart  has  the  same  composition 
as  other  muscular  structures,  but  it  is  of  close,  hard 
texture,  and  therefore  not  easy  of  digestion. 

Sweetbread  is  a  reputed  delicacy,  and  is  gener- 
ally considered  easy  of  digestion.  There  are  two  kinds 
commonly  eaten — one  is  composed  of  the  pancreas, 
and  the  other  of  the  thymus  gland  of  the  calf.  Simply 
cooked  it  is  useful  food  for  convalescents. 

Tripe  consists  of  the  paunch  or  first  part  of  the 
ruminant  stomach  of  the  ox.  Its  involuntary  mus- 
cular fibre  is  easy  of  digestion,  but  it  contains  a  large 
proportion  of  fat  which  renders  it  rich  and  unsuitable 


Chap.  111.]  Poultry  AND  Game,  39 

for  delicate  stomachs.  The  following  is  its  approxi- 
mate composition:  Water,  680;  albuminates,  13*2; 
fat,  16-4  ;  salines,  2*4. 

Poultry  and  game. — Tlie  various  kinds  of 
poultry,  game,  and  wildfowl  are  favourite  forms  of 
food,  and  some  of  them  are  especially  serviceable  to 
invalids  and  persons  of  feeble  digestion.  Their  flesh 
difiers  from  that  of  ruminating  mammals  in  not  having 
its  muscular  fibres  permeated  by  fat,  and  it  is  also 
short-fibred,  and  thei'efore  more  easily  disintegrated. 
Those  with  white  flesh,  as  the  fowl,  guineafowl,  and 
turkey  amongst  poultry,  and  the  pheasant  and  part- 
ridge amongst  game,  are  especially  tender,  delicate 
in  flavour,  and  easy  of  digestion  ;  but  the  flesh  of 
ducks  and  geese  is  dark-c6loured,  harder,  richer,  with 
a  stronger  flavour,  and  is  much  more  diflicult  of 
digestion.  Of  all  these,  the  young  well-fed  domestic 
fowl  or  chicken  is  perhaps  the  most  valuable  to  the 
invalid.  The  young  parti'idge  utuI  lien  pheasant  also 
yield  very  delicate  food.  The  pigeon  has  less  flavour, 
and  the  large  amount  of  fat  in  the  duck  and  goose 
renders  them  unsuited  for  invalids. 

Deprivation  of  the  sexual  organs  at  an  early  age 
is  well  known  to  add  to  the  size,  flavour,  tenderness, 
and  edible  qualities  generally  of  certain  poultry,  as  is 
well  seen  in  the  capon  and  poulard. 

The  flesh  of  game  contains  less  fat  than  that  of 
poultry,  and  has  a  finer  flavour.  It  is  tender  and  easy 
of  digestion.  Keeping  develops  the  flavour  of  game, 
as  is  especially  notable  in  grouse.  The  absence  of  fat 
and  the  finer  flavour  will  often  commend  it  to  invalids 
in  preference  to  poultiy.  Snipe,  quail,  and  woodcock 
are  delicate  in  flavour,  but  they  are  too  rich  for  invalids. 
(Jamefor  invalids  should  only  be  kept  long  enough  to 
secure  tenderness,  and  the  breast  is  the  most  suitable 
part  for  them  to  eat.  Wildfowl  generally  have  close 
and  firm  flesh,  of  strong  and  often  fishy  flavour,  not 
suited  to  the  digestion  of  invalids. 

The  flesh  of  a  youug  hare  is  short-fibred,  very 


40 


Food  in  Health. 


[Part  I. 


tender,  and  of  excellent  flavour  ;  it  is  nearly  as  digest- 
ible as  chicken,  but  more  stimulating. 

The  flesh  of  the  rabbit  when  young  is  fairly 
digestible,  but  when  older  it  becomes  dry  and  hard 
in  cooking,  and  cannot  be  said  to  be  easy  of  digestion. 

The  following  tabic  presents  the  composition  of 
several  kinds  of  fowl : — 


Fat  chicken 
Fat  goose 
Partridge 


Fat. 


3-15 

45 -59 

1-43 


FISH. 

Fish  afford  a  large  and  important  part  of  human 
food.  The  different  kinds  vary  greatly  in  nutritive 
value,  in  edible  quality,  and  in  digestibihty.  The 
relative  proportions  of  fat  they  contain  are  especially 
subject  to  variation,  and  this  determines  greatly 
their  flavour  and  their  facility  of  digestion.  The 
lighter  kinds,  as  the  sole  and  whiting,  contain  least 
fat,  and  are  of  more  delicate  flavour  and  easy  of 
digestion.  Many  contain  a  large  proportion  of  water, 
and  their  nitrogenous  matter  consists  greatly  of  gelatin. 
The  flesh  of  many  fish  has  a  peculiar  odour  and  flavour. 
In  the  brine  of  herring  Triinelhylamin  occurs  in 
abundance. 

The  following  table  gives  the  composition  of  some 
of  the  more  important  kinds  ; — 


Salmon 

Eel       

-Herring  (fresh) 
Sole      


Water. 


74-36 
67-42 
80-71 
86-14 


Albumin- 
ates. 


15-01 
1-2-82 
10-11 
11-94 


Fat 


6-42 

28-37 

7-11 

0-25 


Chap.  HI.]  Food   Value  of  Fish.  41 

Of  the  great  nutritive  value  of  fish  no  doubt  can 
exist,  and  whole  populations  exist  entirely  upon  it. 
It  has  been  maintained  that  a  fish  diet  predisposes  to 
cutaneous  affections,  but  this  is  doubtful.  In  Siberia 
dried  fish  ground  into  powder  is  made  into  a  kind  of 
bread. 

Fish  is  considered  to  be  less  satisfying  and  less 
stimulating  than  the  flesh  of  birds  and  mammals ;  it 
appears  to  be  digested  more  rapidly,  and  therefore 
requires  to  be  taken  at  shorter  intervals  or  in  larger 
quantity.  For  these  reasons  it  forms  an  especially 
useful  food  for  invalids  whose  digestive  powers  are 
unequal  to  cope  with  the  stronger  kinds  of  animal 
food. 

White-fleshed  fishes,  like  the  sole  and  whiting,  con- 
tain very  little  fat ;  turbot,  brill,  cod,  plaice,  flounder, 
etc.,  are  of  this  class. 

In  the  salmon,  the  type  of  red- fleshed  fish,  there 
is,  as  the  above  table  shows,  a  much  larger  pro- 
portion of  fat,  which  is  interspersed  amongst  the 
muscular  fibres  and  accumulated  under  the  skin.  It 
is  most  abundant  in  the  thinner  abdominal  part  of 
the  fish. 

The  pilchard,  sprat,  herring,  and  mackerel,  as  well 
as  the  eel,  contain  much  fat  mixed  with  their  flesh, 
and  these  fishes  are,  on  that  account,  unsuited  to  per- 
sons with  delicate  digestions. 

The  flounder,  like  the  sole  and  whiting,  is  light 
and  easy  of  digestion,  and  has  a  delicate  flavour  if 
■cooked  very  fresh.  Cod  and  haddock  are  not  very 
easy  of  digestion ;  the  former  varying  greatly  in 
quality,  and  sometimes  being  hard  and  tough.  When 
cod  is  in  season,  there  is  a  white  curdy  matter  found 
between  the  flakes  after  boiling  ;  this  consists  of  co- 
agulated albumen,  and  is  absent  when  the  fish  is  out 
of  season. 

Turbot  is  a  fine-flavoured  fish,  and  its  flesh  is 
firmer  and  richer  than  that  of  the  sole,  etc.  Brill 
resembles  turbot,  but  is  of  inferior  flavour. 

There  are  many  circumstances  which  influence  the 


42  Food  in  Health.  ii'arti. 

edible  qualities  of  fish.  It  is  in  the  greatest  perfection 
just  before  spawning  ;  during  that  j)rocess  it  loses  fat 
and  becomes  poor  and  flabby  and  "out  of  season." 
The  salmon  on  its  return  to  the  sea,  after  spawning, 
is  thin  and  wasted,  and  is  regaixled  as  unfit  for  food. 
Immature  fishes,  not  arrived  at  the  spawning  age,  are 
always  in  season. 

The  flavour  of  sea-fishes  caught  in  deep  rapidly- 
flowing  water  off  rocky  headlands,  is  better  than  that 
of  ti.sh.es  found  in  shallow  bays.  Fresh-water  fishes  are 
best  when  taken  in  deep  lakes  or  ponds  with  clear 
water  and  a  rocky  or  stony  bottom ;  the  delicate 
flavour  of  the  fish  caught  in  Alpine  lakes  is- well-known. 

The  common  ray,  and  most  of  the  order  of  cartila- 
ginous fishes — unlike  other  fish  which  cannot  he  cooked 
too  fresh — improve  by  keeping,  for  their  muscular 
fibre,  which  is  firm  and  resistant,  then  yields  and 
becomes  tender.  Turbot  is  also  considered  to  improve 
in  flavour  and  tenderness  by  being  kept  for  a  short  time. 

The  roe,  or  reproductive  organ  of  the  fish,  is  con- 
sidered a  delicacy ;  the  hard  roe  is  the  ovary  of  the 
female,  the  soft  roe  or  milt  is  the  sperniatic  organ  of 
the  male.  Caviare  is  the  salted  hard  roe  of  the 
sturgeon. 

The  swifnming-bladder  of  the  cod  is  known  as  the 
sound. 

Fishes  that  have  no  scales  are  generally  regarded 
as  unwholesome  and  indigestible. 

Fish  dried,  salted,  smoked,  or  pickled  is  much  less 
digestible  than  when  fresh. 

It  has  been  the  custom  to  speak  of  fish  as  an  "  in- 
tellectual "  or  "  brain  food  "  on  account  of  the  phos- 
phorus contained  in  it,  but  much  of  its  reputation  in 
this  respect  may  be  due  to  its  being  readily  digested 
by  persons  of  sedentary  and  studious  habits. 

Louis  Agassiz  spoke  of  fish  as  a  food  "  refreshing 
to  the  organism,  especially  after  intellectual  labour; 
not  that  its  use  can  turn  an  idiot  into  a  wise  or  witty 
man,  but  a  fish  diet  cannot  be  otherwise  than  favour- 
able to  brain  development." 


Chap.  III.]      Crustacea  and  Mollusca. 


43 


The  presumed  aphrodisiac  effect  of  a  fish  diet  we 
are  disposed  to  think  not  without  a  basis  of  experience. 
Tliere  is  a  remarkable  passage  in  Montesquieu's  "  Es- 
prit des  Lois  "  on  this  point.  "  The  founders  of  the 
reh'gious  orders,"  he  says,  "  who  desired  to  subject 
their  unhappy  victims  to  the  impracticable  law  of 
chastity,  wholly  missed  their  end  in  prescribing  for 
them  the  habitual  use  of  fish," 


Crustacea  and  mollusca  (shell-fish). — ]\Iany 
of  the  Crustacea  are  highly  popular  as  articles  of  diet 
— the  lobster,  crab,  crayfish,  shrimp,  and  prawn  espe- 
cially. They  are,  as  their  composition  shows,  highly 
nutritious,  but  they  have  also  the  reputation  of  being 
very  indigestible  ;  indeed,  in  many  persons,  some  of 
them,  the  lobster  and  crab  in  particular,  give  rise  even 
to  toxic  symptoms,  such  as  nauseji,  vomiting,  diarrhoea, 
giddiness,  and  frequently  to  cutaneous  eruptions  of  an 
erythematous  nature.  The  rheumatic  and  gouty  are 
considered  to  be  particularly  prone  to  such  attacks. 
The  following  is  Payen's  analysis  of  the  different  parts 
of  a  lobster  : — 


Soft 

Flesh. 

iutefiial 

awn. 

SUhsUllKtC. 

Water 

76-618 

81-313 

62983 

Nitrogenous  matter 

19-170 

12140 

21  89^-- 

Fatty  matter    ... 

1170 

1-144 

8  2.54 

Saline      „     (ash)        

182:3 

1-749 

l-9;)8 

Non-nitrogenous  (ash)  and  loss 

1-219 

0-354 

4-893 

The  flesh  of  the  lobster  is  more  delicate  and  more 
digestible  than  that  of  the  crab,  and  is  usually  much 
preferred  to  it.  They  both  suffer  decomposition 
rapidly,  especially  in  hot  weather,  and  shoulil  there- 
fore be  eaten  quite  fresh. 

The  spawn  of  the  female  lobster  is  much  used  in 
making  sauces,  both  for  its  colour  and  flavour.     It  is 


44  Food  in  Health.  [Pani. 

highly  nutritious,  as  is  shown  by  the  above  analysis. 
Tlie  fle.sh  of  the  claws  is  more  tender  and  delicate  tliun 
that  of  the  tail.  The  bright  red  part  inside  the  animal 
is  the  ovary. 

The  sea  crawfish,  or  spiny  lobster  {La  Langouste), 
is  by  some  preferred  to  the  lobster ;  others  consider  its 
llesh  inferior  in  flavour  and  tenderness. 

The  flesh  of  the  crab  is  tougher  and  more  resist- 
ant to  the  action  of  the  gastric  juice ;  the  soft  part 
within  the  shell  (liver),  on  account  of  its  richness  and 
the  fat  it  contains,  is  more  likely  to  disagree  than  the 
flesh  of  the  claws. 

The  river  or  fresh- water  crayfish  (VEcrevisse)  is 
the  most  popular  of  ci-ustacea  in  Paris,  where  enorm- 
ous numbers  are  consumed.  Those  taken  from  the 
Meuse  are  thought  the  best.  Being  small,  its  flesh 
is  much  more  delicate  than  that  of  the  lobster.  It  is 
credited  with  aphrodisiac  properties,  and  enters  into 
the  composition  of  Bisque  soup.  They  are  usually 
eaten  hot,  as  they  are  esteemed  more  digestible  then 
than  when  cold. 

Shrimps  and  prawns,  taken  occasionally  and  in 
moderation,  freshly  cooked  in  sea-water,  are  stimu- 
lating and  appetising,  and  capable  of  exciting  appetite 
in  the  feeble  and  anaemic. 

The  oyster  is  the  chief  of  the  edible  Mollusca. 
In  England,  the  mussel,  scallop,  cockle,  periwinkle, 
whelk,  and  limpet  are  also  eaten. 

The  oyster,  when  in  season  and  eaten  raw,  is 
esteemed  a  very  digestible  form  of  food ;  but  when 
cooked,  it  is  by  no  means  easy  of  digestion. 

Analysing  the  whole  contents  of  the  oyster  shell, 
Konig  and  Krauch  found  it  to  contain  : — Water, 
8y-69  per  cent.;  albuminates,  4*95;  fat,  037;  and 
extractives,  2  6  2. 

The  oyster  consists  chiefly  of  a  soft  and  a  hard 
portion.  The  soft  part  is  the  liver;  this  is  very 
digestible.  The  hard  part  is  the  muscle  that  binds  the 
shells  together,  and  is  not  nearly  so  digestible,  and 
should  not  be  given  to  invalids  of  weak  digestion. 


Chap.  III.]  MOLLUSCA.  45 

Of  the  oyster  it  has  been  said,  "if  its  digestibility 
is  great,  its  nutritive  vahie  is  small,  for  ten  dozen 
oysters  would  be  required  to  yield  the  nitrogenous 
substances  needed  in  a  day's  ration." 

Oysters  vary  greatly  in  delicacy  of  flavour ;  some 
are  large  and  coarse ;  others,  like  the  "native,"  small 
and  delicate. 

The  mussel  is  a  nutritious  bivalve,  the  consump- 
tion of  which  is  chiefly  confined  to  the  poorer  classes 
of  seaport  towns.  They  are  usually  cooked  in  their 
own  liquor,  and  vinegar  is  added.  This  mollusc 
has  an  evil  reputation  for  causing  toxic  symptoms, 
often  of  great  severity.  This  is  said  to  happen  more 
frequently  between  May  and  September  than  at  other 
seasons.  Poisoning  by  mussels  has  been  studied  by 
Brieger,  who  succeeded  in  isolating  a  toxic  principle, 
■which  he  names  MytUotoxin  (CgH  ^NOg).  He  con- 
siders it  to  belong  to  the  group  of  Ptomaines,  and 
to  be  developed  in  the  liver  of  these  mollusca. 

It  is  not  necessary  to  dwell  on  the  other  mollusca 
we  have  named  ;  but  a  few  words  must  be  said  of  the 
Escargot,  or  Helix  pomatia  (vineyard  snail),  which 
possesses  so  high  a  reputation  in  France  and  other 
parts  of  the  Continent  for  its  nutritive  qualities. 

They  are  collected  in  considerable  numbers  in  the 
vineyards  of  Burgundy,  Champagne,  Franche-Comte, 
and  Lorraine.  Those  are  preferable  that  are  found 
on  elevated  parts,  and  where  the  soil  is  free  from 
decomposing  organic  matters. 

At  the  end  of  the  winter  season  they  are  con- 
sidered to  be  most  delicate,  having  had  a  long  period 
of  partial  fasting.  As  they  feed  often  on  poisonous 
plants,  especially  on  the  poisonous  solanacete,  it  is 
usual  to  allow  a  few  days  to  elapse  after  their  collec- 
tion before  cooking  them,  in  order  that  they  may  get 
rid  of  any  poisonous  substances  they  may  have  eaten. 
By  cooking,  the  flesh  becomes  compact  and  firm,  some- 
what insipid,  and  not  easy  of  digestion.  It  contains, 
however,  a  large  proportion  of  nitrogenous  matters, 
and  is  no  doubt  highly   nutritive,  and    may  form  a 


46  Food  in  Health.  [Pan  i, 

useful  food  for  the  poor.  It  has  been  called  "the 
poor  m&n's  oyster."  It  enjoys  a  reputation  in  certain 
districts  of  being  peculiarly  beneficial  to  the  con- 
sumptive. Selected  varieties,  seasoned  with  aromatic 
herbs  and  other  condiments,  form  a  costly  article  of 
luxury  for  Parisian  gourmets. 

I?Iilk  and  its  fieri vsuivcs— cream,  butter, 
clicese,  etc. — It  will  be  necessary  to  consider  at 
some  length  the  properties  of  that  very  important 
animal  food — milk — a  food  which  is  remarkable  as 
containing  all  the  alimentary  substances  required  for 
the  support  and  maintenance  of  animal  life,  and  which 
is,  on  that  account,  termed  a  comjylete  or  typical  food. 
The  only  other  complete  food  afforded  by  the  animal 
kingdom  is  eggs. 

Not  only  does  milk  form  the  exclusive  food,  for  a 
time,  of  the  young  of  all  the  mammalia,  but  it  is  also 
capable  of  being  advantageously  employed  as  the  chief 
food  for  adults  under  various  circumstances,  which 
will  be  fully  considered  in  the  second  part  of  this 
work. 

In  milk  we  find  the  four  classes  of  alimentary  sub- 
stances necessary  for  health  combined  in  proporticns 
well  adapted  for  the  period  during  which  growth  is 
active  ;  but  when  applied  to  the  feeding  of  adults,  the 
proportions  of  albuminates  and  fat  are  in  excess  as 
compared  with  the  amount  of  sugar. 

The  percentage  composition  of  good  cow's  milk  ig 
thus  given  by  Parkes  : — 

Sjieciflc  Gravity,  1020  and  over. 
Water  .        .        .        .        .        .     86-8 

Albuminates         .        .        .        .        .      4*0 

Fats 3-7 

Carbohydrates 4*8 

Salts 0-7 

The  albuminates  consist  of  casein  and  a  small 
quantity  of  serum,  or  true  albumen,  which  remains  in 
solution  after  the  casein  is  thrown  down.  Cow's  milk 
is  said  (Parkes)  to  contain  as  much  as  5*25  gi'ammes 
of  albumen  per  litre.     Casein,  the  chief  nitrogenous' 


Chap  III.]    .        Composition  of  Milk.  47 

constituent  of  milk,  differs  from  albumen  in  not  being 
coagulated  by  heat ;  but  it  is  readily  coagulated  by 
acids,  and  also  by  rennet,  an  organic  substance  ex- 
tracted from  the  fourth  stomach  of  the  calf. 

The  fat  of  milk,  as  is  well  known,  can  be  sej)arated 
in  the  form  of  butter.  It  consists  of  glycerides  of 
stearic,  palmitic,  myristic,  oleic,  butyric,  and  some 
soluble  fatty  acids.  It  is  suspended  in  the  fluid  or 
])lasma  of  milk,  in  the  form  of  milk  globules,  and  these 
give  to  milk  its  white,  opaque  appearance. 

The  carbohydrate  of  milk  is  in  the  form  of  lactose, 
lactine,  or  milk  sugar.  It  remains  dissolved  in  the 
fluid  or  plasma  after  the  casein  and  the  fat  globules 
have  been-  separated.  It  is  not  so  sweet,  and  is  less 
soluble  in  water,  than  ordinary  sugar.  It  is  nearly 
insoluble  in  alcohol  and  ether  ;  and  it  reacts  like  grape- 
sugai"  on  the  cupro-potassic  solution.  It  is  not  directly 
prone  to  alcoholic  fermentation,  but  under  the  in- 
fluence of  an  organism  (the  bacillus  acidi  laciici) 
introduced  from  without,  it  is  converted  into  lactic 
acid,  and  it  is  this  which  causes  milk  to  "  turn  sour  " 
on  keeping. 

Lactose.  Lactic;  Avm\. 

The  salts,  together  with  the  water  of  milk,  sup]tly 
the  necessary  inorganic  substances  required  for  the 
nutrition  of  the  animal  organism. 

Potash  salts  are  more  abundant  in  milk  than 
soda  salts ;  and  calcium  phosphate  is  a  considerable 
and  important  constituent,  as  it  is  needed  for  the 
bone  formation  of  young  animals.  These  salts  are 
chiefly  in  the  form  of  chlorides,  phosphates,  and 
suli)hates. 

The  amount  of  salts  in  cow's  milk  varies,  especially 
with  the  animal's  food,  from  0'5  to  0  8  per  cent.  ;  the 
normal  average  is  0*7  to  0-75.  In  poor  milk  it  may 
be  as  low  as  0*3  per  cent. 

The  total  amount  of  solids  in  cow's  milk,  of  an 
average  specific  gravity  of  1030,  is  132  per  cent ,  and 


46 


2*000   IN  hEALTH. 


[Part  I. 


a  pint  (or  20  oz.)  of  such  milk  will  contain  in  round 
numbers — 

350  grains  of  Casein, 

324      „       „  Fat, 

420       „       „  Lactose, 
and  66       „       „  Salts. 


Total 


1,160  grains,  or  more  than  1\  oz.  average 
of  water-free  food. 


If  an  adult  requires  daily  23  oz.  of  water-free  food, 
it  would  take  9  pints  of  milk  of  a  specific  gravity  of 
1030  to  supply  this;  but  such  a  quantity  of  milk 
would  give  a  considerable  excess  of  albuminates  and 
fat,  and  a  very  great  excess  of  water ;  and  although 
this  excessive  proportion  of  water  and  fat  is  essential 
for  the  rapid  growth  and  due  elimination  of  the  young, 
it  would  be  a  wasteful  food  for  an  adult.  So  that  it 
is  not  a  food  well  suited  for  the  nourishment  of  adults, 
unless  mixed  with  other  foods,  which  should  consist 
chiefly  of  carbohydrates. 

It  has,  however,  been  suggested  that  it  might 
prove  a  valuable  food  in  old  age,  and  remedy  the 
defective  tissue  formation  and  elimination  common  at 
that  period. 

Tho  relative  proportions  of  these  difierent  consti- 
tuents vary  considerably  in  the  milk  of  different 
ajiimahj  as  is  shown  in  the.  following  tables  : — 


Feuy's 

Analysis — given  by  Dujardin-Beaumetz. 

ity 

Woman. 

Ass. 

Cow. 

Goat. 

Specific  Gra\ 

1033-5 

1032-1 

1033-4 

103:5-8.) 

Average  Composition  per  litre,  1,000  gramm's. 


Water 

900-10 

914-00 

910  08 

S63-.')2 

Casein 

10-62 

12-30 

28  12 

4ll>7 

Butter 

43-43 

30-10 

34  00 

•-0-G8 

lactose 

76-14 

69-30 

52  16 

48-50 

Salts 

2-14 

4-50 

6  00 

910 

Chap.  III.]  Composition  of  Milk.  49 

The  following  is  quoted  by  Bauer,  after  Konig : — 


Water. 

Casein. 
3-01 

Albnuien. 

Fat. 

Sugar. 

Salts. 

Cow 

87-41 

0-75 

3-66 

4-92 

0-70 

Goat 

86-91 

2-87 

1-19 

4-09 

4-45 

0-96 

Sheep 

81-63 

4-09 

1-42 

5-83 

4-86 

0-73 

Mare 

'.»0  7l 

1-24 

0-75 

1-17 

5-70 

0-37 

lliese  tables,  it  must  be  reraembered,  only  repre- 
sent the  average  composition,  or  the  means  of  several 
analyses,  the  actual  composition  being  somewhat 
variable. 

It  will  be  seen  from  the  first  table  that  the  specific 
gravity  varies  very  little,  the  lowest  being  that  of 
the  ass^  1032-1,  and  the  highest  that  of  the  goat., 
1033-85. 

The  milk  of  the  sheep  is  rarely  used  as  human 
food,  and  therefore  has  less  interest  for  us.  It  is  par- 
ticularly rich  in  casein  and  butter.  The  milk  of  this 
animal,  as  well  as  that  of  the  goat,  would  seem,  ac- 
cording to  the  second  table,  to  liave  much  of  its  nitro- 
genous matter  in  the  form  of  albumen,  which  is  there 
estimated  separately. 

But  if  we  confine  our  attention  to  the  first  table 
we  shall  notice  that  whereas  human  milk  and  ass's 
milk  each  contain  about  the  same  proportion  of  casein, 
cow's  milk  contains  nearly  three  times,  and  goat's  milk 
more  than  four  times,  as  much  casein  (or  nitrogenous 
matter,  i.e.  casein  and  albumen  together)  as  human 
milk. 

On  the  other  hand,  human  milk  and  ass's  milk 
are  richer  in  sugar  than  cow's  or  goat's  milk  ;  human 
milk  being  especially  rich  in  lactose.  Human  milk  is 
also  rich  in  butter,  considerably  more  so  than  the  milk 
of  the  cow  or  the  ass,  but  not  so  rich  in  this  ingredient; 
as  that  of  the  goat.  Of  the  four  milks  compared  together 
in  the  first  table,  goat's  milk  is  richest  in  solfds,  and  con- 
tains  the  largest  proportions  of  nitrogenous  and  fatty 


/ 


5p  Food  in  Health.  iPani. 

constituents,  as  well  as  of  salts ;  but  it  is  compara- 
tively poor  in  sugar.  It  also  contains  a  peculiar 
smelling  acid  (hircin  or  hircic  acid).  It  is  the  most 
highly  nutritious  of  these  milks,  but  it  is  the  least 
digestible. 

Ass's  milk,  on  the  contrary,  contains  tlie  smallest 
amount  of  solids,  but  is  rich  iu  sugar,  although  not 
quite  so  much  so  as  human  milk.  It  is  poor  in  casein 
and  in  fat,  resembling  human  milk  in  all  but  the  latter 
particular.  Ass's  milk  is,  therefore,  light,  sweet,  and 
easy  of  digestion,  and  is  a  most  useful  food  for  })ersons 
whose  stomachs  are  too  delicate  to  digest  cow's  milk 
easily.     It  is  said  to  give  rise  occasionally  to  diarrhcea. 

If  we  now  glance  at  the  second  table  we  shall 
notice  a  certain  resemblance  between  the  composition 
of  mare's  milk  and  ass's  milk.  Mare's  milk  is  poor 
in  solids,  remarkably  so  when  compared  with  that  of 
the  other  animals  in  the  same  table.  It  is,  however, 
proportionately  rich  in  sugar,  and  on  this  account  in 
Tartaiy  it  is  fermented,  and  an  alcoholic  beverage 
known  as  koumiss  is  made  from  it,  of  which  we  shall 
have  to  speak  hereafter. 

The  composition,  quality,  and  quantity  yielded 
of  cow's  milk  are  influenced  by  a  variety  of  cir- 
cumstances— 

1.  There  is  the  influence  of  race.  Aldeniei/s  give 
a  milk  very  rich  in  butter,  long-horns  a  milk  pi'o- 
portionately  rich  in  casein. 

2.  The  period  after  delivery  of  the  calf  also  exerts 
an  influence.  The  milk  which  immediately  succeeds 
delivery  differs  from  ordinary  milk,  and  is  known  as 
colostrum.  It  has  a  somewhat  viscid,  turbid,  and 
yellowish  aspect,  and  strongly  alkaline  reaction.  It 
contains  very  little  casein,  but  much  serum-albumen, 
and  is  particularly  rich  in  all  the  other  solid  con- 
stituents, especially  butter.  It  coagulates  on  boiling. 
The  milk  of  the  cow  may  remain  in  this  condition  for 
nearly  a  month  after  delivery.  It  has  a  sickly  odour, 
and  is  said  to  possess  purgative  properties,  and  to  be 
unfit  for  human  food. 


Chap.  III.]  Milk.  51 

3.  The  milk  -with  a  first  calf  contains  less  water 
and  is  richer,  but  the  quantity  yielded  is  less  than  in 
subsequent  pregnancies. 

4.  The  oftener  the  mammae  are  emptied  the  richer 
the  milk  becomes  in  casein ;  and  the  milk  withdrawn 
at  the  end  of  a  milking  is  always  richer  in  butter  than 
that  at  the  beginning,  as  it  comes  from  the  most  dis- 
tant part  of  the  gland — the  acini. 

The  evening  milk  contains  a  larger  proportion  of 
butter  than  that  of  the  morning. 

5.  The  nature  and  quality  of  the  food  exercise 
considerable  influence  over  the  amount  and  quality  of 
the  milk.  A  poor  diet  soon  leads  to  a  diminution  of  the 
solid  constituents.  Fresh  green  pastures  produce  the 
sweetest-flavoured  and  best  milk.  Beetroot  and  car- 
rots increase  the  amount  of  sugar.  Turnips,  brewers' 
grains,  etc.,  impart  a  peculiar  flavour.  The  colour,  the 
odour,  and  even  poisonous  properties  may  pass  from 
the  vegetables  or  plants  consumed  into  the  milk 
secreted.  In  autumn  it  is  desirable,  on  this  account, 
that  cows  should  not  be  allowed  to  eat  many  of  the  dead 
leaves  which  may  be  scattered  over  their  pastures. 

It  is  a  familiar  experience  that  wet-nurses  have 
to  be  careful  in  their  diet  or  their  milk  will  excite  in- 
testinal disorders  in  the  infants  they  are  suckling  : 
medicines,  also,  taken  by  nurses  will,  through  their 
milk,  influence  the  infants.  It  is  possible  to  take 
advantage  of  this  circumstance,  and  so  administer 
medicated  milk  to  sucking  infants  ;  in  this  way  iodides, 
preparations  of  mercury,  salicylic  acid,  arsenic,  quinine, 
and  other  substances,  may  be  carried,  with  the  milk, 
from  the  imrse  to  the  child. 

The  frequency  with  which  contagious  diseases  are 
communicated  by  milk  necessitates  great  care  in  its 
collection  and  storage. 

Excessive  physical  exertion  and  morbid  mental 
states  are  also  known  injuriously  to  alfect  the  pro- 
perties of  the  milk  secreted  under  such  conditions. 

We  have  already  incidentally  alluded  to  the  fact 
that  milk  undergoes  a  pai'ticular  change  when  it  is 
E  2 


52  Food  in  Health.  [Pani. 

allowed  to  stand  for  a  certain  time,  the  length  of 
which  varies  according  to  the  temperature  to  which  it 
is  exposed.  This  spontaneous  coagtdatioio  of  milk  is 
due  to  the  production  of  lactic  acid,  which  is  fonned, 
as  we  have  shown,  from  the  lactose  of  the  milk  by  the 
action  of  a  ferment  (bacilltis  acidi  lactici)  introduced 
from  without.  It  is  the  casein  in  the  milk  which 
becomes  coagulated.  In  fresh  milk  the  casein  is 
combined  with  calcium  phosphate  Avhich  keeps  it  fluid  ; 
acids  wliich  act  on  the  calcium  phosphate  bring  about 
coagulation  of  the  casein.  The  lactic  acid  when  de- 
veloped converts  the  neutral  alkaline  phosphate  into 
acid  phosphate,  and  the  casein  is  thus  precipitated. 
Warmth  hastens  the  tendency  in  milk  to  spontaneous 
coagulation,  and  it  is  a  common  observation  that  milk 
"  turns  sour  "  much  more  rapidly  in  tlie  heat  of  summer 
than  in  cold  weather  ;  moreover,  contact  with  the 
smallest  quantity  of  milk  that  has  undergone  this 
process  will  rapidly  induce  it  in  fresh  milk. 

It  is  sometimes  noticed  that  milk  which  is  tluid 
and  apparently  fresh  at  ordinary  temperatures,  curdles 
on  boiling ;  this  is  explained  by  supposing  that  lactic 
acid  has  already  been  formed  in  small  quantity,  and 
the  rise  of  temperature  increases  its  energy. 

In  perfectly  fresh  milk  coagulation  may  be  delayed 
by  boiling  it,  or  by  adding  a  small  quantity  of  bicar- 
bonate of  soda,  or  of  salicylic  acid  to  it. 

Casein  produced  by  the  action  of  "  rennet "  on  milk 
"  displays  in  its  properties  a  considerable  difference 
from  the  casein  which  has  been  obtained  by  acidifica- 
tion or  spontaneous  coagulation."  * 

Milk  is  such  an  exceedingly  important  food,  both 
for  the  sick  and  the  sound,  that  it  is  most  essential 
for  all  who  are  responsible  for  the  feeding  of  others  that 
they  should  be  familiar  with  some  systematic  method 
of  examining  it,  in  order  to  test  its  quality  and  purity. 

Good  milk,  as  it  is  withdrawn  from  the  cow,  is 
perfectly  fluid,  often  slightly  frothy  on  the  surface, 
opaque  and  white,  with  a  faintish  buff"  tint.  It  has  a 
•  Bauer,  "Dietary  of  the  Sick,"  p.  50. 


Chap,  iii.i  Milk.  53 

slight,  agreeable,  and  peculiar  odour,  and  a  sweetish 
taste.  On  standing,  a  large  proportion  of  the  fat 
globules  it  contains  rise  to  the  surface,  and  accumulate 
there  as  a  layer  of  "  cream,"  which  is  of  lower  specific 
gravity  than  the  rest  of  the  fluid.  The  average  specific 
gravity  of  cow's  milk  may  be  taken  as  1030,  but  it  varies 
somewhat.  Its  reaction  is  neutral  or  slightly  alkaline, 
but  not  long  after  removal  it  may  be  found  faintly  acid. 

Its  specific  gravity  is  ascertained  by  the  hydro- 
meter or  lactometer ;  it  is  usually  found  to  vary  be- 
tween 1026  and  1034.  The  addition  of  water  lowers 
the  specific  gravity,  and  therefore  a  low  specific  gravity 
is  one  of  the  indications  of  adulteration  with  water  \ 
but  it  is  necessary  to  remember  that,  owing  to  the 
lightness  of  fatty  matter,  an  excess  of  cream  also 
lowers  the  specific  gravity.  A  specimen  of  milk 
containing  26  per  cent,  of  cream  has  been  found  to 
have  a  specific  gravity  of  1019,  and  one  with  80  per 
cent,  of  cream  a  specific  gravity  of  1008.  These 
specimens  when  skimmed  had  a  specific  gravity  of 
1027  and  1026  respectively.  Milk  with  a  specific 
gravity  of  1026  or  1027  unskimmed,  will  when 
skimmed  often  have  a  specific  gravity  of  1030  or 
1031.  It  is  advisable  then  to  skim  the  milk  before 
taking  its  specific  gravity,  and  if  it  is  found  of  a 
lower  specific  gravity  than  1027  or  1028  it  is  highly 
probable  that  it  has  been  watered. 

In  order  to  estimate  the  amount  of  cream  in  a 
given  specimen  of  milk,  a  creamometer  is  employed  ; 
this  consists  of  a  long  glass  tube  graduated  to  100 
parts ;  this  is  tilled  with  milk,  and  then  placed  in  a 
protected  spot  for  twenty-four  hours.  The  cream 
rises  as  a  more  or  less  thick  layer  to  the  top,  and  the 
number  of  degrees  it  occupies  can  be  read  off".  About  8 
per  cent,  is  the  average.  If  it  falls  below  5  per  cent,  it 
is  probable  that  the  milk  is  adulterated  with  water.  In 
some  very  rich  milks  it  may  be  as  much  as  20  per  cent.* 

*  Full  details  for  the  examination  of  milk  will  be  found  in 
Parkes's  "Hygiene,"  and  in  other  works  dealing  with  the  analysis 
of  food. 


54 


Food  in  Health. 


[Part  I. 


Various  methods  have  been  adopted  for  preserving 
milk.  If  a  bottle  be  quite  filled  with  boiled  milk, 
immediately  corked  up,  and  hermetically  sealed,  the 
milk  on  cooling  diminishes  in  bulk  and  a  vacuum  is 
formed.  It  may  then  be  kept  for  some  time,  especi- 
ally if  a  little  cane  sugar  be  added,  which  aids  its 
preservation.  If  the  milk  is  heated  in  a  close  vessel 
to  250'  Fahr.  it  may  be  preserved  for  years.  Boiling 
milk  and  then  adding  sodium  sulphite  or  passing  sul- 
phur dioxide  through  it  is  another  method  of  preserv- 
ing it.  By  adding  a  little  sodium  bicarbonate  and 
sugar,  with  or  without  boiling,  it  may  be  kept  ten  or 
twelve  days.  The  addition  of  salicylic  acid,  of  borax, 
of  boracic  acid,  or  of  boro-glyceride,  is  a  useful  pre- 
servative measure. 

Methods  of  sterilising/  milk  will  be  described  in 
the  appendix. 

Preserved  condensed  milk  is  now  largely 
sold  in  air-tight  tins.  It  is  condensed  by  the  removal 
of  water  in  vacuo,  and  cane  sugar  is  added  in  variable 
quantity.  Condensed  milk  thus  prepared  contains  on 
an  average  26  per  cent,  of  water,  12  of  nitrogenous 
matter,  11  of  fat,  16  of  lactose,  and  22  of  added  cane 
sugar.  There  is  also  an  "unsweetened"  kind  pre- 
pared which  is  better  for  feeding  infants. 

Skimmed  milk  is  simply  ndlk  fi-om  which  the 
cream  has  been  removed  by  skimming,  after  it  has 
stood  some  hours.  It  is  more  easily  digested,  under 
some  circumstances,  than  unskimmed  milk,  as  it  is  less 
lich.     It  contains — 


Letheby. 

Bauer. 

Water        

88-0 

90-63 

Albuminates          

4-0 

306 

Fat 

1-8 

0  79 

Lactose       

5-4 

4-77 

Salts           

0-8 

— 

Ghap;  ni. 


Cream;  Curd  and   Whey 


55 


Cream  varies  somewhat  in  composition  according; 
to  the  quality  of  the  milk  from  which  it  is  ob- 
tained, and  the  method  adopted  of  obtaining  it. 
The  following  table  shows  approximately  its  com- 
position : — 


Water 

Albuminates . 
Fat     ... 

Tiactose 
Sfilts  ... 


Bauer. 


Varies  from  22'0 
2  2 
8-2 
0-74 


to  83-0 
„  7-4 
„  70-2 
„    4-5 


Clotted  or  Devonshii-e  cream  is  solid,  not  fluid 
like  oi'dinary  cream.  The  milk  from  which  it  is  col- 
lected is  previously  heated  just  to  the  point  of  sim- 
mering. It  is  then  allowed  to  stand  and  cool,  and 
the  fatty  matter  rises  to  the  surface  together  with  a 
coagulated  scum,  which  dots  the  cream.  It  is  richer 
and  less  digestible  than  fluid  cream. 

Curd  and  \f  liey. — It  has  already  been  stated 
that  when  an  acid,  or  when  rennet,  is  added  to  milk, 
the  casein  coagulates  and  forms  the  so-called  ciird  of 
milk,  from  which  cheese  is  made,  and  the  fluid  from 
which  it  separates  is  termed  ivhey. 

Rennet  coagulates  milk  with  an  alkaline  reaction, 
and  forms  what  is  called  "sweet  whey."  In  this  pro- 
cess the  casein  is  decomposed  into  the  precipitated 
cheese  and  the  slightly-soluble  whey-albumen.  It  is 
a  process  quite  distinct  from  the  congnlation  of  milk 
by  the  gastric  and  pancreatic  juices,  or  from  that 
produced  by  other  acids  out  of  the  body. 

The  curd  consists  of  casein  with  some  milk 
globules  entangled  in  it.  The  wherj  contains  some 
soluble  albumen  and  fat,  and  a  great  proportion 
of  the  salts  and  lactose,  together  with  some  lactic 
acid. 


56  Food  in  Health.  [Pani. 

Mean  Composition  of  Whey  (Baxjeu). 


Water         

93-3 

Albuminates 

0-82 

Pat 

0-24 

Lactose       

4-65 

Lactic  Acid 

0-33 

Salts           

0-65 

Whey,  though  not  very  nutritious,  is  an  exceed- 
ingly useful  fluid  food  in  some  febrile  and  other 
diseases,  when  milk  cannot  be  digested.  As  it  is  also 
a  pleasant  beverage  it  can  be  given  freely,  and  so  a 
considerable  amount  of  nutritive  substance  may  in 
this  manner  be  administered.  It  also  acts  usefully  as 
a  diuretic.  It  can  be  made  with  lemon  juice,  or  white 
vinegar,  or  white  wine,  or  cream  of  tartar,  or  alum,  as 
well  as  with  rennet.  (In  the  section  on  "  Food  in 
Infancy,"  a  mode  of  preparing  "whey"  will  be  de- 
scribed by  which  a  considerable  proportion  of  casein 
and  fat  globules  are  retained  in  it.) 

BuUerniilk  is  the  milk  that  is  left  after  the 
manufacture  of  butter.  It  is  a  sour-tasting,  thickish 
fluid,  in  which  the  casein  of  the  milk  exists  in  a  finely 
coagulated  state,  a  more  easily  digested  form  than 
when  in  coarse  curd. 

It  contains  but  a  small  quantity  of  fat,  and  the 
lactose  has  been  in  great  part  converted  into  lactic 
acid.     The  composition  as  given  by  Pavy  is  : — 

Water           88*0 

Nitrogenous  Matter          4-1 

Fatty  Matter          07 

Lactine         6-4 

Saline  Matter         0*8 

It  is  a  very  nutritious  fluid,  and  its  use  has  been 
largely  advocated  by  German  physicians  in  feeble 
states  of  the  digestive  organs  on  account  of  its 
digestibility. 

Koumiss. — Milk  can  be  made  to  undergo  alco- 
holic fermentation  by  the  conversion  of  its  lactose  into 
alcohol  and  carbonic  acid. 


Chap.  HI.] 


Koumiss  and  Kefyr. 


57 


Advantage  has  been  taken  of  this  property  in 
certain  countries  to  produce  an  alcoholic  drink  from 
milk.  The  Khirgis  tribes  and  the  Tartars,  who  dwell 
in  the  immense  plains  surrounding  the  Caspian  Sea, 
utilise  mare's  milk  for  tliis  purpose,  and  prepare  from 
it  an  alcoholic  beverage  which  is  known  as  koumiss. 
There  are  two  or  three  qualities  prepared  of  varying 
strength. 

The  following  comparison  of  the  composition  of 
mare's  milk  and  koumiss  is  quoted  from  Hartier  by 
Dujardin-Beaumetz : — 


In  1,000  parts. 

Mare's  MUk. 

Koumiss. 

Albuminates           

19  to  28 

11-20 

Fatty  Matter         

12   „    15 

1200 

Lactose 

53   „  57 

22-00 

Lactic  Acid 

— 

U-oO 

Carbonic  Acid         

— 

7-85 

Alcohol        



16-50 

Salts  (Ash) 

0-280 

0-28 

A  form  of  koumiss  is  also  prepared  in  England 
from  cow's  milk. 

It  is  a  valuable  food  in  the  dietetic  treatment  of 
phthisis  and  other  diseases. 

Kefyr  is  another  fermented  drink,  prepared  in 
the  mountains  of  the  Caucasus  from  cow's  milk.  This 
fermentation  is  brought  about  through  the  agency  of 
a  micro-organism,  the  Dispora  caiicasica,  which  is 
added  to  the  milk,  and  it  possesses  the  propei'ty  of 
converting  the  lactose  into  alcohol  and  carbonic 
acid. 

As  cow's  milk  contains  proportionately  much  less 
sugar  than  mare's  milk,  kefyr  therefore  contains  less 
alcohol  than  koumiss. 

The  following  analysis,  quoted  by  Dujardin- 
Beaumetz,  shows  the  relations  between  cow's  milk 
and  kefyr : — 


S8 


Food  in.  Health. 


[Part  I. 


Skimmed  Cow's 

Kefyr  (Medium 

In  1,000  parts. 

Milk. 

Quality). 

Sp.  Gr.  1028. 

Sp.  Gr.  1-026. 

Albuminates          

48-00 

38-00 

Fats             

38-00 

20-00 

Milk  Sugar            

41-60 

22-025 

Lactic  Acid            

— 

4-00 

Alcohol       



800 

Water  and  Salts 

873-00 

904-975 

Oalaxymc  is  the  name  given  to  a  fermented 
drink  made  on  the  Continent  from  milk  by  adding 
to  it  sugar  and  a  special  ferment. 

Deschiens,  in  France,  has  employed  the  same 
ferment  as  is  used  in  the  preparation  of  the  best 
alcohols.  A  certain  proportion  of  this  and  a  certain 
amount  of  sugar  are  dissolved  in  a  little  water  and 
added  to  a  bottle  of  milk,  which  is  then  hermetically 
sealed.  This  rapidly  undergoes  fermentation,  and  an 
effervescing  milky  beverage  is  produced,  containing  1 
per  cent,  of  alcoliol  and  a  large  amount  of  carbonic 
acid. 

The  following  is  the  composition  of  the  beverage 
thus  prepared*  : — 


In  1,000  parts. 
Butter 
Albuminates 
Lactose 
Alcohol     ... 
Carbonic  Acid 
Lactic  Acid 
Water 


Sp.  Gr.  1023. 
3240 
27-65 
29-50 
1-200 
7-00 
10-50 
880-95 


Butter. — Butter  is  one  of  the  most  digestible  of 
animal  fats,  and  one  of  the  most  agreeable  and  most 
delicate  in  flavour. 

It  is  obtained,  as  is  well  known,  by  the  process  of 
churning  cream  or  milk,  which  causes  the  fat  globules 
to  run  together  and  coalesce  into  a  solid  mass. 


Dujarclin-Beaumetz,  "L'Hygifene  Alimentaire,"  p.  43. 


Chap.  III.]  Butter.  59 

It  is  rarely  made  from  any  but  cow's  milk,  which 
alone  yields  butter  of  the  pleasant  delicate  flavour  so 
generally  appreciated. 

The  butter,  when  formed,  is  well  washed  and 
kneaded  with  water,  for  the  purpose  of  freeing  it,  as 
completely  as  possible,  from  adherent  casein  and  the 
other  constituents  of  milk.  The  more  completely  this 
is  done,  the  better  will  the  butter  keep.  It  is  usual 
also  to  add  a  certain  proportion  of  common  salt  to  aid 
in  its  preservation ;  this  varies  in  amount  according 
to  whether  the  butter  is  to  be  consumed  "fresh"  or 
"salted." 

Kdnig  gives  the  composition  of  good  butter  as  : — 

Fat 87-0  {/ 

Casein         O'o 

Milk  Sugar  0-5 

Water        11-7 

Parkes  gives  the  water  as  vaiying  from  5  to  10 
per  cent. ;  when  purposely  mixed  up  with  butter  to 
increase  its  weight,  as  much  as  23  6  per  cent,  of 
water  has  been  detected  in  fresh,  and  28*5  in  salt, 
butter. 

Such  large  admixtures  of  water  can  be  detected  by 
-melting  the  butter,  when  the  water  will  collect  below 
the  oil. 

All  butter  contains  a  small  amount  of  casein  which 
is  taken  up  from  the  milk ;  the  best  butter  contains 
the  least.  The  changes  in  butter  which  render  it 
rancid  are  apparently  dependent  on  alterations  in  the 
casein,  whicli  acts  as  a  ferment  and  liberates  fatty 
acids.  The  more  completely,  therefore,  the  casein  is 
removed  fx-om  it,  the  better  will  the  butter  keep. 

The  fat,  which  should  amount  to  from  86  to  92 
per  cent.,  consists  of  volatile  and  non-volatile  fatty 
acids,  combineti  with  glycerine.  The  volatile  acids  are 
butyric,  caproic,  capiylic,  and  capric ;  and  the  non- 
volatile, stearic,  palmitic,  and  oleic. 

Salt  preserves  butter  by  checking  the  decomposi- 
tion of  the  casein,  and  sugar  has  the  same  effect. 


6o  Food  in  Health.  [Pani. 

Butter  may  be  made  to  keep  longer  either  Ijy 
repeated  washings  or  by  melting  down,  both  of  which 
processes  diminish  its  agreeable  fresh  flavour ;  or  by 
the  more  common  method  of  adding  salt.  Cover- 
ing it  with  water  which  has  been  boiled,  or  in 
summer  time  with  iced  water,  will  help  to  pre- 
serve it. 

Butter  melts  at  a  comparatively  low  temperature ; 
it  is  rarely  completely  solid  at  a  temperature  of  82" 
Fahr. ;  hence  it  is  prepared  with  difficulty  in  southern 
countries,  and  is  more  especially  a  product  of  the 
north . 

Butter,  when  perfectly  fresh,  is  one  of  the  most 
easily  digested  forms  of  fatty  matter,  and  it  is  on  that 
account  a  very  valuable  food  ;  but  when  it  is  rancid, 
or  when  its  fatty  acids  have  been  set  free  from 
exposure  to  heat,  as  in  cooking,  it  is  often  badly 
tolerated  by  the  stomach. 

Cheese. — Cheese  is  composed  of  the  casein  or 
curd  of  milk,  together  with  a  variable  amount  of  the 
fat  of  milk,  according  to  the  manner  in  which  it  is 
prepared. 

The  milk  is  usually  coagulated  by  the  addition  of 
rennet,  and  a  certain  amount  of  salt,  5  or  6  per  cent,, 
is  added.  The  fat  globules  are  entangled  in  the 
coagulated  casein. 

The  curd,  after  coagulation,  is  subject  to  pressure, 
in  order  to  express  as  much  of  the  retained  fluids, 
milk  and  whey,  as  possible.  It  is  placed  in  moulds 
for  a  time  to  consolidate,  and  subsequently  it  is  re- 
moved and  ranged  on  shelves  in  a  cool  situation,  where 
it  remains  for  some  time  to  ripen.  In  this  ripening 
process  the  fats  increase  at  the  expense  of  the  casein, 
and  volatile  fatty  acids  are  developed,  which  impart 
to  the  cheese  its  characteristic  odour  and  flavour.  The 
richer  the  cheese  in  fat,  the  more  highly  flavoured  it  is 
capable  of  becoming.  These  fermentative  processes 
may  go  on  to  actual  putrefaction,  and  even  poisonous 
ptomaines  may  be  developed  ;  or  vegetable  organisms 
in  the  form  of  mould  (Aspergilltts  glaucus,  blue  and 


Chap.  III.]  Cheese.  6i 

green  mould,  and  Sporendonema  caaei,  red  mould)  may 
appear  in  it,  as  well  as  a  microscopic  animal,  the 
acarus  domesticus,  or  cheese  mite. 

There  are  a  great  many  varieties  of  cheese.  In 
the  first  place,  there  is  the  so-called  "  fresh,"  or  "  sour- 
milk,"  cheeses,  as  they  are  sometimes  termed,  such  as 
our  own  cream  cheeses.  These  are  not  intended  to  be 
kopt,  but  to  be  eaten  as  soon  as  made,  "  When 
cheese  is  made  from  sour  milk,  the  milk  is  gently 
warmed  to  about  50°  C,  in  order  to  obtain  a  firmer 
coagulation  of  the  casein.  The  whey  is  then  pressed 
out,  and  the  resulting  sour-milk  cheeses  are  generally 
eaten  fresh."     (IJauer.) 

Cheeses,  however,  that  are  intended  to  be  kept  are 
made  from  fresh  milk. 

The  quality  and  chai'acter  of  the  sevei-al  varieties 
of  cheese  depend  to  some  extent  upon  whether  they 
are  made  from  skimmed  or  unskimmed  milk,  or  from 
milk  to  which  cream  is  added. 

The  richer  cheeses,  as  Stilton  and  Double  Glo'ster, 
contain  a  considerable  amount  of  added  cream.  The 
best  quality  Cheshire  is  made  from  unskimmed  milk  ; 
the  second  quality  Chester,  Glo'ster,  and  many 
American  cheeses  are  made  from  milk,  some  of  the 
cream  of  which  has  been  removed.  Dutch  and  Par- 
mesan cheese  and  some  of  the  poorer  qualities  made 
in  many  counties  in  England,  are  made  from  skimmed 
milk. 

The  poorer  cheeses  keep  best,  but  become  very 
hard  and  dry.  Parmesan  has  even  to  be  grated  ;  the 
richer  fatty  cheeses  are  more  prone  to  decomposi- 
tion. 

The  average  percentage  composition  of  cheese 
(single  Glo'ster)  is  thus  given  in  Parkes*  : — 

Water         3G-0 

Albuminates           ...         ...         31'0 

Fats ...  28-5 

Siilts           4-5 

*  " Hygiene"  :  Cth  ed.,  by  Notter. 


62 


Food  in  Health. 


[Part  I. 


Dividing  cheeses   into  three  classes,  their   mean 
analyses  13auer  gives  as  follows  : — 


Uich. 

Midtlliiig. 

Poor  Cheese. 

Water 

35-75 

46-82 

48-02 

Albuminates    . . . 

27-16 

27-62 

32-65 

Fat       

30-43 

20-54 

8-41 

Extractives 

2-53 

2-97 

6-80 

Ash       

4-13 

3-05 

4-12 

The  following  analyses  of  well-known  varieties  of 
cheese  are  compiled  from  various  authorities  : — 


From 
Skim 
Milk. 

Dutch. 

Chesliiro 

Gru- 
yere. 

Camem- 
bert. 

Roque- 
fort. 

Water 

44-0 

36-10 

35-92 

40-0, 

51-94 

34-55 

Albuminates ... 

44-8 

29-43 

25-99 

31-5 

18-90 

26-52 

Fat      

6-3 

27-54 

26-34 

24-0 

21-05 

30-14 

Undefined  Sub- 
stances       ... 

— 

6-93 

7-59 

1-5 

4-40 

3-72 

Salts 

4-9 

4-16 

3-0 

4-71 

5-07 

Cheese  is  an  exceedingly  valuable,  nutritive,  and 
economical  food  on  account  of  the  large  proportion  of 
nitrogenous  substances  it  contains — twice  as  much, 
weight  for  weight,  as  meat ;  it  is  also  agreeable  to  the 
palate.  Cheese  with  bread  forms  a  popular,  conve- 
nient, and  highly  nutritious  diet  for  the  labouring 
man.  When  taken  at  the  end  of  a  meal  by  the 
opulent  classes,  it  is  rather  as  a  condiment  than  a 
food,  especially  when  highly  flavoured  and  in  a  state 
of  advanced  decomposition,  as,  for  example,  old  Stilton 
and  Gorgonzola. 

Cheese  is  popularly  regarded  as  a  food  difficult  of 
digestion,  but  this  has,  doubtless,  been  much  exag- 
gerated. The  poorer,  hai'der  kinds  of  cheese,  which 
contain  a  large  proportion  of   casein,    are  certainly 


Chap.  III.)  Eggs.  63 

difficult  to  digest,  but  the  richer,  softer,  finer-flavoured 
and  less  compact  cheeses  by  no  means  merit  this 
reproach,  and,  in  small  quantity,  exercise  a  stimulant 
action  on  the  stomach, 

Eggs.— Eggs  form  another  complete  food,  like 
milk.  They  contain  all  the  elements  of  the  blood, 
and  the  organism  of  the  young  chick  is  developed 
from  them.  But  when  I'egarded  in  the  light  of  a 
complete  food  the  shell  must  be  taken  into  account, 
for  it  is  from  the  shell  that  certain  essential  con- 
stituents of  the  organism  of  the  chick  are  obtained.  In 
the  process  of  incubation  the  earthy  salts  in  the  shell 
are  dissolved  by  phosphoric  acid,  which  is  developed 
by  the  oxidation  of  phos[)horus,  and  they  are  thus  in 
a  condition  to  be  absorbed.  In  eggs,  therefore,  we 
find  a  highly  nutritious  food  in  a  concentrated  form. 

The  egg  of  the  domestic  fowl  is  the  one  chiefly 
utilised  for  human  food,  but  eggs  of  the  duck,  goose, 
turkey,  and  guinea  fowl  are  occasionally  eaten.  Plo- 
vers' eggs  are  greatly  esteemed  for  their  delicacy  of 
flavour.  The  eggs  of  all  birds  have  the  same  compo- 
sition, and  are  suitable  for  food,  but  their  quality  and 
flavour  depend  greatly  on  the  food  of  the  bird  which 
yields  them. 

Bauer  gives  750  grains  as  the  mean  weight  of  a 
hen's  egg,  of  which  105  grains  are  shell,  405  white, 
and  240  yolk.  Parkes  roughly  estimates  the  average 
weight  of  a  hen's  egg  to  be  2  ounces,  and  to  range 
between  600  and  950  grains,  and,  including  the  shell, 
in  every  100  grains  he  calculated  there  would  1)6  10 
grains  of  shell,  22'8  of  albuminates  and  fat,  and  G7  2 
of  water.  He  also  estimated  that  an  egg  weighing 
2  ounces  would  contain  about  200  grains  of  solids. 
It  has  beea  calculated  that  such  an  egg  would  yield 
110  grains  of  nitrogenous  substance,  82  grains  of  fat,' 
and  1 1  grains  of  saline  matter. 

The  composition  of  the  shell  is  estimated  at  91  per 
cent,  calcic  carbonate,  6  per  cent,  calcic  phosphate, 
and  3  per  cent,  organic  matter. 


64 


Fuoo  IN  Health. 


[Part  1. 


The  wliite  of  the  egg  contains  less  solids  than  the 
yolk  and  much  less  fat,  and  consists  chiefly  of  albumen 
dissolved  in  water  and  enclosed  in  a  delicate  mem- 
brane. Egg  albumen  resembles  serum  albumen,  but 
is  not  identical  with  it.  It  coagulates  at  70°  Cent.- 
(158°  Fahr.)  It  contains  a  small  amonntof  fat  and  salts. 

The  yolk  contains  much  more  fat  than  the  white. 
Its  chief  albuminous  constituent  is  the  characteristic 
proteid  substance  vitellin,  and  besides  the  ordinary 
fats,  olein  and  palmitin,  the  yolk  contains  cholesterin, 
much  lecithin,  and  a  yellow  colouring  matter ;  also 
inorganic  salts,  extractives,  and  a  little  grape  sugar. 
Landois  gives  the  following  comparative  analyses  of 
the  wliite  and  the  yolk  of  egg. 


Water         

Albuminates 
Fats,  etc.    ... 
Mineral  Matter     ... 
Pigment  Extractives 


White  of  Kgg. 

Yolk. 

84-8 

51-6 

120 

15-0 

2-0  • 

300 

1-2 

1-4 

— 

2-1 

It  is  here  seen  that  the  yolk  differs  from  the  white 
chiefly  in  its  greater  richness  in  solids,  especially  in 
fats,  and  in  the  presence  of  pigment.  The  saline  con- 
stituents are  the  same  as  those  found  in  the  blood; 
the  white  has  an  excess  of  chlorides,  the  yolk  an  excess 
of  phosphates. 

The  yolk  is  of  more  importance  than  the  white  from 
an  alimentary  point  of  view,  as  it  contains  a  quantity 
of  fat  as  well  as  a  peculiar  form  of  albumen,  whereas 
the  white  is  chiefly  a  simple  solution  of  albumen.  In 
some  persons  certainly,  if  not  in  all,  white  of  egir,  if 
taken  uncooked  in  large  quantities,  gives  rise  to  albu- 
minuria, but  the  slightest  amount  of  cooking  will 
usually  prevent  this. 

Eggs  are  an  easily  digested  food  if  taken  raw  or 
Ushtly  cooked,  but  if  cooked  so  as  to  be  hard  they  are 


Chap.  III. 


Eggs. 


i*S 


difficult  of  digestion.  Some  persons  present  the 
peculiarity  of  being  unable  to  take  eggs  in  any  form 
or  in  tlie  smallest  quantity  without  manifesting  toxic 
symptoms. 

Eggs  may  be  preserved  for  a  long  time  by  various 
devices  which  are  intended  to  prevent  the  entrance  of 
air  tlirough  the  porous  shell. 

Eggs  are  extensively  employed  in  ordinary  cookery, 
as  well  as  in  the  diet  of  the  sick,  and  it  has  been  said 
tliat  they  can  be  prepared  in  more  than  five  hundred 
different  ways. 

The  yolk  of  egg  is  considered  unsuitable  in  the 
nric  acid  diathesis  because  of  the  amount  of  lecithin 
it  contains,  and  eggs  are  altogether  forbidden  by  many 
physicians  in  albuminuria. 

The  well-known  lait  de  poule  is  made  by  beating 
up  the  yolk  of  egg  in  hot  water,  and  adding  sugar  and 
some  aromatic  flavouring  substance,  such  as  orange- 
flower  water;  sometimes  a  little  rum  or  cognac  is  added. 

It  may  be  useful  to  introduce  here  the  following 
table  of  the  various  constituents  of  the  ash  of  the 
most  important  animal  foods  as  given  by  Bauer : — 


S 

S 

3 

■S 

m  d 

1^ 

o 

3-3 

-i 

3 

:j 

&> 

u 

s 

£ 

O 

3-21 

O 
070 

s 

QQ 

o 

Ash  of  Flesh 

41-27 

3-63 

2-82 

42-54 

1-56 

3-85 

„    „  Milk 
„    „  Hen's  1 
Egg    ...    / 

24-67 

9-70 

22-05 

3-05 

0-53 

28-45 

0-30 

14-28 

19-22 

17-52 

8-44 

2-43 

116 

38-05 

0-96 

13-97 

We  may  call  attention  to  the  richness  of  animal 
flesh  in  potassium  and  in  phosphoric  and  sulphuric 
acids,  and  its  comparative  poorness  in  sodium,  calcium, 
and  chlorine ;  to  the  richness  of  milk  in  calcium  and 
chlorine ;  and  to  the  richness  of  pggs  in  sodium,  iron, 
and  phosphoric  acid. 


66 


CHAPTER  IV. 


VEGETABLE  FOODS. 


We  derive  from  the  vegetable  kingdom  a  great  variety 
of  foods,  many  of  them  of  a  highly  nutritious  character, 
and  therefore  of  great  importance  to  the  human  race. 

The  foods  obtained  from  the  vegetable  kingdom, 
like  those  derived  from  the  animal  world,  contain  both 
albumen  and  fat,  but,  as  a  rule,  in  vegetable  foods  the 
non-nitrogenous  constituents  are  greatly  in  excess  of 
the  nitrogenous  ones,  and  occur  chiefly  as  carbo- 
hydiates ;  and,  save  in  the  case  of  certain  fruits  and 
seeds,  they  contain  but  little  fat. 

The  remarkable  difference  in  these  respects  be- 
tween animal  and  vegetable  food  is  well  shown  in  the 
follovvincc  table  : — 


Kitrosenous 
Constituents. 

Fat. 

Carbohydrates. 

Salts. 

Fat  Beef     ... 

51-4 

45-6 

30 

Lean  ,, 

89-4 

5-5 

— 

5-1 

Ppu  Flour  ... 

27-3 

o-s 

68-9 

3-0 

Wheat 

16-6 

0-9 

81-9 

0-6 

Rice 

7-7 

0-4 

91-2 

0-7 

Vegetable  foods  differ  further  from  animal  foods  in 
being  less  digestible  and  less  capable  of  complete 
assimilation  by  the  digestive  organs  of  man. 

There  are  several  modifications  of  albuminates 
found  in  vegetable  as  well  as  in  animal  food. 

1 .  There  is  vegetable  albumen,  which  separates  from 


Chap.  IV.] 


Vegetable  Foods. 


67 


vegetable  juices  by  coagulation  when  heated,  and  then 
presents  a  close  resemblance  to  egg  albumen  both  in 
properties  and  composition. 

2.  There  is  legumin  or  vegetable  casein,  abundant 
in  the  seeds  of  the  Leguminosce,  and  resembling  in  all 
essential  particulars  the  casein  of  milk,  and  being,  like 
it,  precipitated  from  its  solution  by  rennet  and  acetic 
acid,  but  not  by  heat. 

3.  There  is  gluten,  found  in  large  amount  in 
wheaten  flour  and  in  other  cereals.  It  is  broken  up 
by  alcohol  into  vegetable  Jibrin  and  gliadin. 

The  following  table  will  show  the  close  relation- 
ship in  chemical  composition  between  some  of  these 
vegetable  and  animal  albuminates: — 


C. 

H. 

N. 

0. 

S. 

Flesh  Albumen    ... 

52-89 

7-17 

16-18 

22-18 

1-58 

Egg 

53-40 

7-0 

15-70 

22-40 

1-60 

Vegetable,, 

53-06 

7-33 

16-58 

21-93 

110 

Milk  Casein 

53-55 

7-10 

15-83 

25- 

32 

I/egumin  ... 

51-48 

7-02 

18-22 

22-88 

0-40 

Syntonin 

53-97 

7-21 

15-57 

22-03 

1-21 

Vegetable  Fibrin . . . 

54-49 

7-35 

16-91 

20-41 

0-84 

Certain  other  nitrogenous  substances  are  found  in 
vegetables,  such  as  asparagin,  not  belonging  to  the 
albuminates,  but  these  are  eliniinated  in  the  form  of 
urea,  and  have  no  nutritive  value. 

The  vegetable  fats  are  some  solid  and  some  liquid, 
at  ordinary  temperatures  ;  they  usually  contain  a  large 
l)roportion  of  free  fatty  acids.  The  so-called  "  non- 
drying  "  oils  are  most  valued  as  food,  and  of  these  the 
oil  of  the  olive  is  especially  esteemed.  Of  the  "  drying  " 
oils  (i.e.  those  that  gradually  harden  into  a  resinous 
mass  on  exposure  to  air),  that  of  the  poppy  is 
said  to  be  the  most  useful  as  food,  and  the  most 
palatable. 
F  2 


68  Food  in  Health.  [Pan  i. 

Vegetable  foods  are,  as  a  rule,  particularly  rich  in 
carbohydrates,  an  impoitant  class  of  alimentary 
principles,  which  derive  their  name  from  the  fact 
that  they  contain  oxygen  and  hydrogen  in  the 
proportion  to  form  water^  Of  these  starch  is  the 
most  important.  It  abounds  in  all  plants,  and 
especially  in  the  seeds  of  the  Gerealia  and  Legvr 
tninosce,  and  in  the  potato  and  other  tubers.  By 
the  action  of  certain  reagents,  and  also  by  that  of 
some  of  the  digestive  ferments,  the  insoluble  starch 
is  converted  into  soluble  dextrin,  and  ultimately  into 
grape  sugar. 

Similar  properties  are  possessed  by  inulin  and 
Uchenin  (from  Iceland  moss),  and  by  the  various 
kinds  of  gum  and  mucin.  . 

Cellulose,  which  exists  in  abundance  in  all 
plants,  is  closely  allied  to  starch,  but  it  is  only 
capable  of  serving  as  human  food  when  quite  young 
and  tender.  It  tends  quickly  to  become  "  woody,"  and 
is  then  not  only  itself  incapable  of  digestion  by  man, 
but  liinders  the  digestion  of  the  other  constituents 
associated  with  it. 

The  different  kinds  of  sugar  are  important  carbo- 
hydrates, found  also  in  many  vegetables.     They  are 
not  only  nutritious  in  themselves,  but  they  are  most 
valuable  from  the  property  they  possess  of  giving  an ' 
agreeable  flavour  to  other  foods. 

Orape  sugar  is  found  in  the  juices  of  most  sweet 
frnits.  Cane  sugar  is  much  sweeter  and  is  found  in 
the  sugar-cane,  certain  species  of  maple,  beetroot,  etc. 
Fruit  sugar,  melitose,  inosite,  and  mannite,  are  varieties 
of  sugar  possessing  little  importance  as  food  ;  the  same 
remark  applies  to  pectin  or  fruit  jelly,  to  the  vegetable 
acids,  and  the  glucosides. 

The  most  important  vegetable  foods  are  derived 
from  those  plants  which  produce  farinaceous  seeds, 
i.e.  seeds  yielding  meal  ov  flour.  The  seeds  of  the 
Cerealia,  one  of  the  grass  tribe,  and  of  the  Leguminosce 
or  pulse  tribe,  are  of  the  greatest  value  and  usefulness 
in  this  respect. 


Chap.  IV.]  The  Cerealia.  69 

To  the  former  belong  those  well-known  "  grains," 
wheat,  barley,  oats,  rye,  maize,  rice,  etc.  ;  and  the 
latter  include  those  familiar  articles  of  food,  peas, 
beans,  lentils,  etc. 

The  Cerealia. — The  seeds  of  the  cereals  are,  of 
all  the  products  of  the  vegetable  kingdom,  those  best 
adapted  for  the  food  of  the  human  face,  and  we 
accordingly  find  them  almost  universally  spread  over 
the  surface  of  the  globe.  ,  They  contain  a  large 
quantity  of  nutritious  substances  condensed  into  a 
small  space,  and  they  are,  therefore,  convenient  both 
for  storage  and  transportation,  and  being  dry  they  can 
be  preserved  for  a  long  period  without  deterioration. 

They  are  rich  in  nitrogenous  substances,  the 
various  grains  containing  from  5  to  14  peV  ceht.  ;  rich 
also  in  starch  and  cellulose,  and  they  contain'  small 
and  varying  amounts  of  gum,  sugar,  and  fat. 

They  also  contain  a  considerable  proportion  of 
mineral  substances,  chiefly  in  the  form  of  phosphates 
of  lime,  magnesia,  potash,  and  soda,  together  with 
small  amounts  of  iron  and  silica.  .  It  mUst,  however, 
be  remeu.oered  that  the  chemical  composition  of  these 
grains  is  influenced,  to  a  certain  extent,  by  the  nature 
of  the  soil  in  which  they  are  grown,  and  the  manure 
with  which  it  is  dressed. 

The  seeds  of  the  cereals,  before  being  used  for 
human  food,  are  usually  ground  into  meal.  Tliis 
process  has  for  its  object  not  only  the  reduction  of 
the  hard  seeds  to  powder,  but  also  the  separation  and 
removal  of  the  outer  indigestible  tunic,  composed  of 
woody  cellulose,  by  which  the  seed  is  enclosed.  That 
portion  of  the  seed,  however,  which  is  richest  in 
gluten  lies  directly  beneath  ihe  outer  coat  of  cellulose ; 
it  is  therefore  practically  impossible  completely  to 
remove  this  outer  coat  without  at  the  same  time 
removing  a  portion  of  the  highly  nutritious  gluten- 
containing  layers. 

The  following  table  exhibits  the  relative  average 
composition  of  the  more  important  cereal  grains : — 


70 


Food  in  Health. 


[Part  I. 


Nitro- 

Starch, 

Sub- 
stances. 

Fat. 

Sugar, 
Gum,  etc. 

Cellulose. 

Ash. 

Water. 

Wheat... 

12-42 

1-70 

67-89 

2-66 

1-79 

13-56 

Rye       ... 

11-43 

1-71 

67-83 

2-01 

1-77 

15-26 

Barley  ... 

11-16 

2-12 

65-51 

4-80 

2-63 

13-78 

Oats      ... 

ll-7;i 

6-04 

0.3-43 

10-83 

3-05 

12-72 

Maize    . . . 

10-05 

4-76 

66-78 

2-84 

1-69 

13-88 

Rice 

7-81 

0-69 

76-40 

0-78 

1-09 

13-23 

Oats,  it  will  be  seen,  are  especially  rich  in  fatty 
and  mineral  substances,  and  also  in  indigestible 
cellulose.  Maize  also  is  relatively  rich  in  fat,  but 
slightly  deficient  in  salts.  Barley  contains  more  fat, 
more  indigestible  cellulose,  and  move  salts  than  wheat, , 
but  less  nitrogenous  substances  and  le.ss  digestible 
carbohydrates.  Rice  is  seen  to  be  rich  in  starch,  but 
defective  in  nitrogenous  and,  indeed,  in  all  the  other 
solid  constituents. 

The  next  table  gives  the  composition  of  different 
kinds  of  flour,  and  shows  also  the  difference  in 
composition  between  the  finely  and  the  coarsely 
ground  flours  : — 


Nitro- 

Starch, 

genous 
Sub- 

Fat. 

Sugar, 
Gum, 

Cellu- 
lose. 

Ash. 

Water. 

Stances. 

etc. 

Wheat,  finely  ground 

8-91 

Ml 

74-28 

0-33 

0-51 

14-86 

„     coarselv     „ 

11-27 

1-22 

73-65 

0-84 

0-84 

12-18 

Rye,  finely           „ 

10-21 

1-64 

73-54 

0-64 

0-98 

13-99 

, ,     coarsely       „ 

11-06 

2-09 

67-78 

2-61 

1-69 

14-77 

Barley  Meal 

10-89 

1-23 

71-85 

0-47 

0-63 

14-83 

Pearl  Barlev 

7-25 

1-15 

76  19 

1-36 

1-23 

12-82 

Oat  Meal 

14-29 

5-65 

65-73 

2-24 

2-02 

10-07 

Maize  Meal 

14-0 
7.43 

3-80 
0-89 

70-68 

0-86 

10-60 

Rice  (ground) 

77-62 

14-15 

Chap.  IV.]  Wheat.  j* 

The  ash  consists  of  jiotash,  soda,  lime,  magnesia, 
and  iron  oxide  in  varying  proportions,  combined  with 
chlorine,  phosphoric,  sulphuric,  atid  silicic  acids,  the 
phos])hates  being  greatly  in  excess. 

Of  all  the  various  cereal  giains  commonly  used 
as  food,  wheat  is  the  most  largely  consumed  and 
most  extensively  cultivated.  It  is  rich  in  solids,  and 
contains  but  little  water ;  it  therefore  presents  much 
nutriment  in  small  bulk.  The  whole  of  the  grain  is 
digestible  after  its  two  outer  coats  have  been  i-emoved. 
It  yields  a  finer  flour  than  other  grains,  and  makes  a 
white  bread.  The  proportion  of  nitrogenous  suV)- 
stances  contained  in  it  is  large;  as  much  as  14  to  15 
per  cent,  in  the  hard  wheats  of  Italy  and  Sicily. 
These  consist  of  soluble  albumen  and  gluten.  Gluten 
really  consists  of  four  nitrogenous  substances,  which 
have  been  named  gluten-casein,  gliadin,  gluten-fibrin, 
and  mucedin.  A  nitrogenous  substance,  termed 
cerealin,  regarded  by  some  as  merely  a  form  of 
diastase,  is  also  found  in  the  inner  envelope  ;  it -is 
capable  of  ti'ansformiug  starch  into  dextrin,  sugar, 
and  lactic  acid.  Wheat  contains  an  abundance  of 
carbohydrates,  from  60  to  90  per  cent.,  consist- 
ing chiefly  of  starch,  dextrin,  and  sugar.  A  small 
amount  of  cholesterin  is  found  in  wheat.  It  is  rich 
in  phosphates,  especially  in  potassium  and  magnesium 
phosi)hate. 

Its  chief  defects  as  a  food  are  the  small  amount  of 
fat  (1'7  per  cent.)  it  contains,  and  the  absence  of  those 
salts  of  the  vegetable  acids  which  are  converted  in  the 
system  into  carbonates. 

The  grain  of  wheat,  free  from  the  husk,  is  usually 
ground  into  flour  before  it  is  employed  for  food.  The 
outer  yellowish  coat  of  the  grain  is  known,  when 
separated,  as  bran,  and  the  inner  white  part  as  flour. 
The  usual  yield  is  about  80  per  cent,  of  flour,  16  of 
bran,  and  4  of  loss. 

The  flour  is  divided  into  different  qualities,  accord- 
ing to  its  fineness,  the  third  or  coarsest  quality  being 
known  as  pollards  or  hran-flour. 


72 


Food  in  Health. 


[Part  I. 


The  hard  wheats  yield  a  flour  richer  in  gluten  than 
the  soft  ones,  and  therefore  more  nutritious. 

The  gluten  cells  are  especially  accumulated  in  the 
inner  portion  of  the  cortical  layer,  which  is  richest 
also  in  fat  and  salts,  and  this  part  of  the  grain  has, 
on  that  account,  a  high  nutritive  value. 


Stuuctl'bi;  of  Grain  of  Wueat  (x  200). 
a.  Cells  of  the  bran  ;  b,  cells  of  thin  cuticle ;  c,  gluten  cells ;  d,  starch  cells. 


The  above  figure  *  illustrates  these  points  in  the 
structure  of  the  wheat  grain. 

The  use  of  "  whole  meal,"  containing  all  the  con- 
stituents of  the  grain,  has  been  advocated  on  account 
of  the  richness  in  nutritive  constituents  of  the  outer 
coats  ;  but  the  bran-cells,  it  must  be  remembered,  are 
exceedingly  hard  and  indigestible,  and  may  prove 
irritating  in  certain  conditions  of  the  mucous  mem- 
brane of  the  alimentary  canal.     In  the  finest  flour 

*  From  Laudois'  "  Text-Book  of  Human  Physiology." 


Chap.  IV.]  Barley.  73 

almost  all  the  bran  is  separated  ;  this  certainly  seems 
wasteful  and  undesirable,  as  bran  contains  15  per 
cent,  of  nitrogenous  substances,  3-5  per  cent,  of  fat, 
and  5*7  of  salts.  Methods  of  grinding  are  now  adopted 
so  that  the  outer  and  more  indigestible  layers  of  bran 
— "  the  two  or  three  outer  and  highly  silicious  layers  " 
— can  be  si^parated  from  the  highly  nutritious  inner 
tunic,  and  the  flour  so  produced  is  known  as  "  decorti- 
cated whole- wheat  meal." 

We  have,  however,  found  samples  of  bread  made 
from  such  meal  prove  indigestible  in  some  instances ; 
and  it  is  very  important,  if  whole-wheat  is  used,  that 
it  should  be  ground  very  fine,  as  the  harder  outer 
coats  are  very  irritating,  especially  where  there  is  any 
tendency  to  gastro-iutestinal  catarrh  or  dysenteric 
conditions. 

In  habitual  constipation  the  presence  of  the  indi- 
gestible bran  in  the  flour  used  for  making  bread  often 
acts  usefully  as  an  intestinal  stimulant. 

The  central  white  i)art  of  the  grain  is  particularly 
rich  in  starch. 

A  yranular  preparation  of  wheat  is  also  made  by 
a  special  manner  of  grinding,  and  known  as  "  semo- 
lina" (Fr.,  semoule).  It  is  made  from  the  inside  of 
the  grain  of  hard  wheats,  which  are  rich  in  gluten. 
It  is  used  for  making  into  puddings  and  adding  to 
soups,  etc.  The  couscousou  of  Algeria  is  also  a 
granular  preparation  of  wheat.  Macaroni,  vermicelli, 
and  pate  d'Jtalie  are  made  from  hard  Italian  wheats 
rich  in  gluten. 

Barley. — The  meal  of  barley  is  very  nutritious, 
and  is  largely  used  in  fattening  animals.  The  Greeks 
and  Romans  trained  their  athletes  on  barley  {hor- 
dearii).  It  is  rich  in  nitrogenous  substances,  which 
consist  of  gluten-casein,  gluten-fibrin,  mucedin,  and 
albumen,  it  is  especially  rich  in  iron  and  phosphoric 
acid.  It  is  not  so  well  suited  for  making  bread  as 
wheat  flour ;  the  bread  is  heaviei-,  less  digestible,  and 
is  said  to  be  rather  laxative. 

Scotch  or  pot  barley  consists  of  the  grain  without 


74  Food  in  Health.  [Parti. 

the  husks.  Pearl  barley  is  merely  the  grain  deprived 
of  husk,  and  rounded  and  polished. 

Barley  bread  is  usually  made  of  a  mixture  of 
wheat-flour  with  barley-meal. 

Pearl  barley  is  much  used  for  making  barley- 
water,  a  slightly  nutritious  beverage  much  used  in 
sickness.  Barley  is  largely  used  in  the  preparation 
of  tnalt. 

OatSi— Oatmeal  is  a  highly  nutritioiis  food.  As 
will  be  seen  by  reference  to  the  preceding  tables,  both 
the  grain  and  the  meal  ai-e  I'ich  in  nitrogenous  sub- 
stances and  also  in  fat. 

Oatmeal,  according  to  Bauer's  table,  contains  14-29 
per  cent,  of  nitrogenous  substances,  and  5 '05  i)er  cent, 
of  fats.  It  is  therefore  the  richest  of  all  the  cereal 
meals  in  both  these  alimentary  principles.  Gluten- 
casein,  or  avenin,  forms  a  considerable  part  of  the 
nitrogenous  constituents.  This  is  closely  related  to 
the  legumin  of  peas  and  beans.  Dujardin-Beaumetz, 
Avho,  in  conjunction  with  M.  Hardy,  made  an  exami- 
nation into  the  value  of  oatmeal  as  a  food  for  gi'owing 
children,  has  published  the  following  analysis,  which 
differs  somewhat  from  that  of  Bauer,  and  gives  a  still 
larger  percentage  of  fat : — 

Water 8-7 

Fats 7-5 

Starch 64-0 

Nitrogenous  Substances     .         .         .         .  11'7 

Salts 1-0 

Cellulose,  and  other  Substances  .         .         .  6  "6 

He  attributes  the  fine  muscular  development  of  the 
Scottish  Highlanders  to  their  large  consumption  of  oat- 
meal in  childhood.  The  high  nutritive  value  of  oats, 
as  a  food  for  animals  that  are  called  upon  to  give 
out  great  muscular  activity,  is  well  known. 

San.son  has  separated  a  stimulating  principle  from 
oats,  which  he  found  especially  abundant  in  black  oats, 
and  which  he  considers  exerts  an  exciting  influence  on 
horses,  lasting  for  about  an  hour  after  a  feed  of  oats. 


Chap.  IV.]  Rye  ;  Maize.  75 

Oats  contain  a  large  proportion  of  indigestible 
cellulo.se ;  and  owing  to  the  absence  of  adhesive 
quality  (such  as  is  possessed  by  the  gluten  of' wheat)  in 
its  nitrogenous  constituents,  it  cannot  be  made  into 
bread.  It  can,  however,  be  made  into  "  cakes,"  and 
as  it  is  much  more  readily  cooked  than  wheat  or  barley, 
it  is  for  that  reason  found  most  valuable  for  making 
"porridge"  and  "gruel,"  the  latter  being  a  highly 
nutritious  and  agreeable  beverage  much  valued  by 
invalids. 

It  has  been  recommended  as  a  food  particularly 
suitable  to  soldiers  during  war,  "  because  it  contains 
much  nutriment  in  small  bulk ;  because  it  can  be 
eaten  for  long  periods  with  relish,  and  keeps  \in- 
changed  for  a  long  time."  * 

Groats  is  the  grain  freed  from  its  integument, 
and,  when  crushed,  forms  "  Embden  groats,"  used  for 
making  gruel. 

Oatmeal  porridge  is  found  to  act  as  a  slight  laxa- 
tive with  some  persons,  and  in  some  others  it  causes 
dyspeptic  symptoms,  which  disappear  on  discontinuing 
its  use, 

Rye. — Rye  is  much  consumed  on  the  Continent, 
especially  in  parts  of  Russia  and  Germany.  The 
grain,  which  has  a  close  resemblance,  in  outward 
aspect,  to  wheat,  is  white  internally,  but  brown  on 
the  outside,  so  that  rye-meal  makes  a  "  black " 
bread.  It  is  equal  to  wheat  in  nutritive  value,  but 
contains  less  vegetable  fibrin  and  more  casein  and 
albumen.  It  also  contains  a  peculiar  odorous  sjib- 
stance,  and  makes  a  sour-tasting,  dark  bread,  which 
often  disagrees  with  persons  unaccustomed  to  its  use 
and  causes  diarrhoea. 

Rye  is,  of  all  the  cereals,  the  grain  most  liable 
to  be  aliected  by  "  ergotism,"  due  to  the  attack  of 
a  parasitic  lufigus.  Ergolised  or  spurred  rye  causes, 
when  taken  as  food,  poisonous  symptoms,  the  most 
serious  of  which  are  convulsions  and  gangrene. 

]TI:iize — Maize  is   highly  nutritious,    and    most 
*  Paikes's  "Hygiene,"  8th  edit.,  by  Notter. 


76  Food  in  Health.  [Pani. 

analyses  agree  in  attributing  to  it  the  largest  propor- 
tion of  fat  of  all  the  cereals  ;  but,  as  will  have  been 
noticed,  Bauer,  in  the  tables  given  above,  ascribes  to 
oats  a  still  larger  proportion  of  fatty  constituents.* 

Maize  (Indian  corn)  is  now  extensively  cultivated 
in  Europe,  and  its  flour  is  largely  substituted  for  that 
of  wheat.  It  has,  however,  a  peculiar  flavour  not 
approved  of  by  many.  In  the  green  and  succulent 
state  the  grains  are  cooked  in  North  America  as  a 
fresh  vegetable,  like  green  peas. 

Hominy  is  a  preparation  of  maize.  Owing  to  its 
deficiency  in  gluten,  maize-meal  is  ill  adapted  for 
making  bread  unless  mixed  with  some  wheaten  or 
rye  flour ;  but  it  is  often  made  into  cakes,  like  oat- 
meal, which  are  palatable  and  nutritious,  such  as  the 
"  hoe-cake  "  of  the  United  States.  Polenta,  so  largely 
consumed  by  the  poorer  classes  in  Italy,  is  composed  of 
maize  meal.  Maizena,  or  corn-flour,  is  prepared  from 
the  meal  of  maize,  by  treating  it  with  a  weak  solution 
of  caustic  soda,  which  removes  its  peculiar  unpleasant 
flavour,  but  at  the  same  time  deprives  it  of  some  of 
its  nutritive  qualities. 

On  account  of  the  large  amount  of  fat  contained 
in  maize  it  is  apt,  if  kept  long,  to  acquire  an  unplea- 
sant rancid  taste.  Maize  is  used  largely  for  feeding 
and  fattening  animals,  for  which  purpose  it  is  espe- 
cially suitable,  because  of  its  richness  both  in  fat  and 
nitrogenous  substances. 

Rice. — Rice,  largely  cultivated  in  the  Fast,  and 
forming  the- staple  food  of  many  Oriental  peoples,  is  a 
grain  of  much  less  nutrient  value  than  the  preceding. 
It  is  comparatively  poor  in  nitrogenous  substances,  the 
amount,  however,  varying  considerably  in  difterent 
specimens,  from  3  to  7*5  per  cent.  It  is  also  very 
poor  in  fat  and  in  salts  ;  its  chief  constituent  is  starch, 
which  exists  in  rice  in  a  very  digestible  form.  In 
the  prepared  state  it  also  contains  very  little  of  the 

*  The  older  tables  of  Letheby,  quoted  by  Pavy,  give  to  maize- 
meal  8'1  per  cent,  of  fatty  matter,  and  to  oatmeal  5G  ;  and  tliose 
of  Payen  8'8,  as  compared  with5'5. 


Chap.  IV.)  Millet  ;  Sorghum.  77 

indigestible  cellulose,  a  circumstance  which  adds  to  its 
value  as  a  food.  It  has  some  analogy  in  composition 
with  the  potato. 

Rice  as  ordinarily  met  with  has  had  the  husk 
removed,  and  been  "  whitened,"  i.e.  the  inner  cuticle 
or  red  skin  has  been  removed  by  passing  it  through  a 
machine  for  the  purpose. 

Rice  is  too  poor  in  nitrogenous,  fatty,  and  mineral 
substances  to  be  a  suitable  food  by  itself;  it  would 
have  to  be  taken  in  too  large  quantities,  and  much  of 
the  starch  it  contains  would  therefore  be  wasted.  But 
it  is  a  very  valuable  food  when  mixed  in  proper  pro- 
portions with  other  alimentary  substances  richer  in 
fat  and  albuminates. 

The  ready  digestibility  of  its  starch  granules 
renders  it  a  very  suitable  food  for  persons  with  an 
irritable  intestinal  mucous  membrane. 

It  cannot,  by  itself,  be  made  into  bread,  but  it  is 
often  mixed  with  wheat  flour  to  make  a  very  white 
bread,  and  it  is  frequently  made  into  cakes  with  the 
help  of  adhesive  substances. 

It  should  not  be  boiled,  but  thoroughly  steamed 
when  cooked  by  itself,  as  boiling  removes  some  of  the 
small  amount  of  niti'ogenous  and  saline  matters  it 
contains,  and  so  further  lessens  its  food  value. 

inillet,  sorgliiim  or  diiriiia,  buck^vlieat.— 
A  few  other  grains  of  subordinate  value,  such  as 
those  just-named,  are  employed  as  food  in  different 
countries. 

Millet  (Panicum  miliaceum  and  other  genera  of 
grasses)  belongs  to  the  Cerealia  ;  it  is  largely  consumed 
on  the  West  Coast  of  Africa,  in  Algeria,  in  some  parts 
of  China,  India,  and  the  South  of  Europe. 

The  composition  of  millet  is  thus  given  by  Konig 
(excluding  ce^^w/ose)  :  Water,  12'3  ;  albuminates,  11-3; 
fats,  3"6  ;  carbohydrates,  67'3 ;  salts,  2-3.  The  ash 
contains  much  silica  and  phosphates.  As  might  be 
inferred  from  its  composition,  it  makes  a  good  nu- 
tritious bread. 

Durrha  or  sorghum  belongs  to  a  different  tribe  of 


78  Food  in  He  alt  it.  [Parti. 

grasses  from  the  foregoing  (Sorghum  vtilgare),  but  has 
much  the  same  ]>roperties.  It  is  ground  and  made 
into  bread  in  India,  China,  and  other  countries. 

Buckwheat  (Farjo-pyrum  esculenium)  is  not  a  cereal, 
but  belongs  to  the  natural  order  of  Polygonacece.  It  has 
been  introduced  into  Europe  from  Central  Asia,  and 
is  known  in  France  as  sarazain  or  hJ4  noir.  The 
composition  of  buckwheat  meal,  as  given  by  Bauer,  is 
as  follows: — Water,  14-27;  nitrogenous  substances, 
9-28  ;  fat,  1-89  ;  starch,  cellulose,  etc.,  70-68  ;  ash,  0  86. 
It  makes  a  fairly  nutritious  and  palatable  bread, 
largely  consumed  in  Brittany.  Cakes  made  of  buck- 
wheat are  also  popular  in  Holland  and  the  United 
States.  In  England  it  is  largely  grown  for  feeding 
pheasants  and  other  game. 

The  LegmninossE  or  pulses. — The  ripe  seeds  of 
many  of  the  Leguuiinosse,  such  as  beans,  peas,  and 
lentils,  surpass  all  other  farinaceous  seeds  in  the  large 
amount  of  nitrogenous  substances  they  contain.  This 
occurs  chiefly  in  the  form  of  vegetable  casein  or  legu- 
min,  but  they  also  contain,  in  addition,  a  little  albu- 
men and  other  proteids,  together  with  much  stai-ch. 
By  their  richness  in  albuminates  they  greatly  excel 
the  cereals  in  actual  nutritive  constituents.  Lentils, 
for  example,  contain  about  double  the  amount  of 
nitrogenous  substances  that  ordinary  wheat  does. 
These'  leguminous  seeds  are  therefore  the  best  suited 
by  their  composition  to  replace  animal  food. 

Peas  and  beans  contain  much  sulphur  and  jjIios- 
phorus  in  combination  with  legumin  ;  they  are  richer 
also  than  the  cereal  grains  in  potash  and  lime,  but 
poorer  in  phosphoric  acid  and  magnesia. 

Owing  to  the  large  proportion  of  albuminates  they 
contain  they  form  a  valuable  addition  to  other  food 
stuffs  containing  much  starch  or  fatty  matter ;  and  in 
combination  with  rice  they  form  the  staple  food  of 
many  Indian  races.  Eaten  also  with  animal  fat 
(bacon  and  beans)  they  constitute  a  highly  nourishing 
food.     They  are  especially  useful  when  much  exercise 


Chap.  IV.1 


Feas  and  Beans. 


79 


is  taken  ;  and  both  men  and  animals  can  subsist  upon 
them  alone  for  long  periods. 

Their  defects  as  compared  with  the  cereals  are  their 
relative  indigestibility,  their  unsuitability  to  bread- 
making,  and  their  less  agreeable  taste,  "About  6-5 
per  cent,  of  the  ingested  pea  passes  out  unchanged, 
and  starch  cells  giving  a  blue  reaction  with  iodine  are 
found  in  the  faeces ;  much  flatus  is  also  produced  by 
the  hydrogen  sulphide  formed  from  the  legumin." 
(I'arkes.) 

The  following  table  shows  the  mean  composition  of 
the  pulses  as  compared  with  that  of  wheat  {Bauer) : — 


Nitro- 

1 

Water. 

genous 
Substances 

Fat 

Starch,  etc. 

Cellulose. 

Ash. 

^\^leat 

13-56 

12-42 

1-70 

67-89 

2-66 

1-79 

Beans 

13-60 

23-12 

2-28 

!     .53-63 

3-84 

3-53 

Peas  . . . 

14-31 

22-63 

1-72 

:     53-24 

5-45 

2-65 

Lentils 

12-51 

24-81 

1-85 

54-78 

3-58 

2-47 

Landois'  estimate  differs  somewhat  from  the  pre- 
ceding. "Peas,"  he  says,  "contain  18-02  proteids 
and  34: -81  starch;  beans,  28-54  and  37-50;  lentils, 
29 -31  and  40;"  and  he  adds,  "  on  account  of  the  large 
amount  of  proteids  they  contain,  they  are  admirably 
adapted  as  food  for  the  poorer  classes." 

Beans. — There  are  several  varieties  of  beans  used 
as  food  :  there  is  the  common  horse  bean,  grown  in 
the  fields,  and  the  Windsor  or  broad  bean  grown  in 
gardens  ;  the  latter  contains  more  starch,  less  cellulose, 
and  rather  more  fat  than  the  former.  Then  there  is 
the  common  haricot  or  French  bean  and  the  scarlet 
runner,  both  used,  when  fresh,  as  green  vegetables, 
the  seeds  and  pods  being  cooked  together.  The  dried 
seeds  of  the  former,  known  as  haricots  blancs,  are 
largely  consumed  on  the  Continent  as  a  table 
vegetable,  and  afford  a  very  nutritious  and  palatable 


8o  Food  in  Health.  [Pani. 

food.  They  contain,  a^ccording  to  Payen,  25*5 
per  cent,  of  nitrogenous  substances,  55*7  starch, 
etc.,  2  9  cellulose,  2-8  fat,  3-2  ash,  and  9-9 
water. 

Peas. — Of  peas  there  are  also  several  varieties  : 
the  common  field  pea  is  grown  as  food  for  cattle,  and 
the  garden  pea  [Fisum  sativum)  is  eaten  both  as  a 
fresh  and  dry  vegetable.  Dried  peas  contain  rather 
less  nitrogenous  and  fatty  matter  than  beans,  and 
rather  more  cellulose. 

Lentils. — Lentils  have  of  late  years  become  a 
popular  food  in  Britain,  and  are  now  largely  im- 
ported from  Egypt.  This  is  the  most  nutritious  of  all 
the  pulses,  and  contains  the  largest  proportion  of 
nitrogenous  substances.  It  has  the  further  advantage 
of  being  remarkaVjly  rich  in  iron — its  ash  containing 
as  much  as  2  per  cent,  of  the  oxide — and  also  in  phos- 
phate of  lime  ;  and  it  has  a  further  advantage,  especi- 
ally over  peas,  in  the  absence  of  sulphur,  and  there  is 
therefore  not  tlie  same  objectionable  tendency  to  the 
liberation  of  hydrogen  sulphide  in  the  alimentary 
canal.  It  makes  an  excellent  soup,  and  it  will,  no 
doubt,  take  the  place,  more  and  more,  of  pea-meal  for 
this  purpose. 

Rci'alciita-arabica,  revalesciere,  erva- 
lenta,  are  the  names  of  a  highly  nutritious  food 
which  has  long  been  sold  as  especially  suited  to  in- 
valids. It  appears  to  be  largely  composed  of  lentil 
flour  mixed  with  pea-,  bean-,  and  maize-meal,  to  which 
oat-  and  barley-meal  are  occasionally  added.  It  has 
probably  also  been  exposed  to  the  heat  of  an  oven, 
and  so  made  more  digestible. 

Professor  Beneke  has  suggested,  as  an  excellent 
food  for  invalids,  fine  lentil  flour  combined  with  a 
certain  proportion  of  rye  flour,  so  as  to  increase  the 
relative  amount  of  starch. 

It  is  necessary  to  bear  in  mind  that  the  dry  legu- 
minous seeds  require  careful  and  thorough  cooking. 
It  is  best  to  soak  them  for  some  time  in  cold  rain 
water,  and  then  boil  them  slowly  in  water  free  from 


Chap.  IV.]  Roots  and  Tubers.  8i' 

chalk,  as  lime  salts  form  insoluble  compounds  with 
legumin. 

Roots  and  tubers. — The  various  roots  and 
tubers  employed  as  food  are  valuable  chiefly  on  ac- 
count of  the  amount  of  starch  they  contain  ;  they  are 
vastly  inferior  in  nutritive  value  to  the  cereals  and 
pulses,  as  they  contain  a  relatively  large  amount  of 
water  and  a  comparatively  small  proportion  of  albu- 
minates. Many  contain  a  considerable  quantity  of 
sugar  as  well  as  starch,  and  also  some  pectiii  or 
vegetable  jelly.  Some  contain  vegetable  acids, 
chiefly  combined  with  potash,  and  these  salts  give 
them  their  well-known  and  important  anti-scorbutic 
properties. 

The  potsito. — This  tuber,  or  swollen  underground 
stem  of  the  Solanum  tuberosum,  is  the  most  important 
of  these  foods.  It  is  a  very  productive  vegetable,  and 
therefore  well  repays  cultivation,  and  when  cooked, 
forms  a  palatable  and  easily  digested  food.  It  is  not, 
however,  tit  to  be  made  the  exclusive  food  of  a  people, 
as  was  the  case  some  years  ago  in  Ireland,  when  it 
was  calculated  that  the  potato  formed  from  tliree- 
fourths  to  four-fifths  of  the  entire  food  of  the  Irish 
people,  and  that  an  adult  Irishman  consumed  10|  lb. 
of  potatoes  daily,  or  3|  lb.  to  each  meal. 

Since  the  outbreak  of  the  potato  disease,  and  the 
famine  in  Ireland  which  followed  as  a  consequence, 
Indian  com  has  been  largely  cultivated  in  its 
place. 

The  average  percentage  composition  of  the  potato 
(Konig)  is:  Water,  75-77;  nitrogenous  substances, 
1-79;  fat,  0*16;  starch,  20-56;  cellulose,  0-75;  ash, 
0-97  ;  asparagin  and  atiiidic  acid  are  found  amongst 
the  nitrogenous  constituents.  The  juice  of  the  potato 
is  acid,  and  contains  vegetable  acids  combined  with 
potash,  soda,  and  lime  ;  these  give  it  its  anti-scorbuiic 
properties.  The  ash  yields  phosphoric  and  sulphuric 
acids,  chlorine,  silica,  together  with  potash,  soda,  lime, 
magnesia,  and  oxide  of  iron. 


82  Food  in  Health.  tParti. 

It  will  thus  be  seen  that  the  potato  is  chiefly  r€>- 
markable  for  the  large  percentage  of  starch  it  contains, 
while  it  is  poor  in  nitrogenous  constituents,  and 
contains  scarcely  any  fat.  Starch  is  largely  extracted 
from  potatoes  for  commercial  purposes. 

It  has  already  been  said  that  owing  to  its  poorness 
in  albuminates  the  potato  is  unfit  to  form  an  ex- 
clusive food,  but  it  is  a  most  valuable  adjunct  to 
other  foods  richer  in  nitrogenous  substances,  such  as 
meat  and  fish  ;  while,  taken  with  butter-milk,  which 
contains  a  large  quantity  of  the  nitrogenous  sub- 
stance casein,  it  composes  a  good,  sufficient,  and 
cheap  food. 

The  starch  of  the  potato  has  the  advantage  of 
being  very  digestible  ;  its  granules  are  contained  in 
the  cells  of  the  cellular  tissue  of  the  tuber,  sur- 
rounded by  the  acid  albuminous  juices.  In  cooking, 
the  albuminous  juices  are  coagulated,  the  starch 
granules  absorb  the  watery  part  of  the  juices,  swell 
up,  and  break  down  the  containing  cells,  so  that  the 
potato  assumes  a  loose,  "mealy"  or  "floury"  ap- 
pearance. If  this  change  does  not  take  place  the 
potato  is  close,  waxy,  and  watery. 

To  avoid  the  loss  of  salts,  potatoes  are  best  boiled 
in  their  skins,  and  steamii  g  is  the  best  method 
of  cooking  them,  as  they  then  lose  none  of  their 
salts. 

Although  the  potato  is  easily  digested  Avhen 
"mealy"  or  "floury,"  it  is  not  so  when  close  and 
watery,  and  should  not  then  be  eaten  by  pereons  with 
feeble  digestions.  The  value  of  the  potato  as  a 
preventive  of  scurvy  has  been  referred  to ;  and  it  is 
therefore  a  useful  vegetable  to  be  taken  on  long 
sea  voyages. 

The  quality  and  flavour  of  potatoes  vary  greatly 
with  soil  and  season ;  those  are  best  that  are  grown 
on  sandy  or  readily  permeable  soils.  They  are  injured 
by  long  keeping,  hy  frost,  etc. 

The  sweet  potato,  from  the  Batatas  edulis,  has 
a  tuber  rich  in  starch  (16  per  cent.)  and  sugar  (10  per 


Chap.  IV.]  Arrowroot.  83 

cent.),  and  used  to  be  eaten,  like  the  ordinary  potato, 
in  Europe  before  the  introduction  of  the  latter.  It 
becomes  mealy  when  boiled,  and  is  a  wholesome  and 
useful  food,  but  too  sweet  to  eat  with  meat  as  a  vege- 
table. It  is  largely  eaten  by  the  poorer  classes  in 
some  parts  of  America,  and  also  in  the  south  of  France 
and  Spain. 

The  yam»  the  large  tuber  of  the  Dioscorea  hatatus 
and  other  species,  is  a  good  substitute  for  the  potato, 
as  it  cooks  "  mealy,"  and  forms  a  wholesome  and 
agreeable  food.  It  contains  a  large  amount  of  staich, 
and  has  not  the  objection  of  being  sweet  like  the  sweet 
potato.  It  is  largely  consumed  in  some  tropical 
countries,  and  is  also  cultivated  in  pai-ts  of  Europe. 

The  Jeriisalcin  artichoke  is  a  well-known 
edible  tuber,  grown  in  most  vegetable  gardens  in 
England.  It  has  a  sweet  taste  and  remains  watery 
after  cooking,  and  does  not  become  mealy  like  the 
potato  ;  this  is  owing  to  its  not  containing  starch.  It 
is  less  digestible  than  the  potato,  and  contains  but 
very  little  nutritive  substances,  and  is,  therefore, 
practically  of  little  importance  as  a  food.  It  contains 
14  per  cent,  of  sugar,  about  3  per  cent,  of  nitrogenous 
substances,  and  about  2  per  cent,  of  inulin,  a  prin- 
ciple isomeric  with  starch. 

Arrowroot,  derived  from  the  tuber  of  the 
Maranta  arundiruicea,  is  a  pure  foim  of  starch,  highly 
valued  as  an  ea^^ily -digested  carbohydrate.  It  is  cul- 
tivated in  the  West  Indies  and  other  tropical  countries. 
That  imported  from  Bermuda  is  considered  the  best. 
Its  "  quality  is  judged  of  by  its  whiteness,  by  the 
grains  being  aggregated  into  little  lumps,  and  by  the 
jelly  being  readily  made,  and  being  firm,  colourless, 
ti'ansparent,  and  good-tasted.  The  jelly  remains  firm 
for  three  or  four  days  without  turning  thin  or  sour ; 
whereas  potato-flour  jelly  in  twelve  hours  becomes  thin 
and  acescent  Under  the  microscope  the  starch 
grains  are  easily  identified,"  and  any  adulteration 
with  sago,  tapioca,  or  potato-s^ch  can  thus  be 
detected. 
o  2 


§4  Food  in  Health.  tPartl. 

-Arrowroot  is  simply  a  pure  starchy  food,  and  is 
valuable  as  a  bland  unirritating  carbohydrate  for 
invalids.  It  is  usefully  mixed  with  clear  meat  soups 
and  extracts. 

Tous  les  mois  is  another  pure  form  of  starch, 
derived  from  the  tuberous  root  of  the  Canna  edulis, 
grown  in  the  West  Indies.  It  is  of  the  same  value 
and  use  as  arrowroot.  Its  starch  granides  have  beau- 
tifully marked  and  distinct  concentric  lines,  and  exceed 
those  of  all  other  starches  in  size. 

Tapioca,  also  a  pure  starch,  is  obtained  from  the 
tuberous  roots  of  the  manihot  utilissima,  cultivated 
in  Africa,  India,  and  other  hot  countries.  Its 
starch  grains  are  small,  with  a  central  hilum,  and 
three  or  more  often  adhere  together  into  compound 
grains. 

It  is  an  agreeable  and  easily-digested  carbo- 
hydrate, beneficial  both  for  invalids  and  the  healthy. 
It  is  usefully  added  to  meat  soups  and  broths,  or 
made  into  puddings  with  milk. 

Sago  is  another  starch,  obtained  from  the  pith  of 
the  stems  of  several  species  of  palm.  It  is  usually 
met  with  in  the  "  granulated  "  form  or  "  pearl  sago," 
small  spherical  grains  prepared  by  mixing  sago-flour 
with  water  into  a  paste,  and  then  granulating.  It  is 
used  like  tapioca  for  making  light  puddings  and  for 
adding  to  soups,  and  is  a  useful  and  easily-digested 
food  for  invalids  and  dyspeptics. 

Salep,  consisting  chiefly  of  starch  and  mucil- 
aginous matter,  is  derived  from  the  tubercles  of  several 
species  of  orchids,  and  is  imported  into  England  from 
the  East  It  possesses  nutritive  and  soothing  properties. 

The  following  "  roots "  are  of  a  more  succulent 
uacure,  and  are  commonly  used  as  fresh  veget- 
ables. 

The  carrot  is  the  root  of  the  wild  Caucus  carota 
improved  by  cultivation.  When  young  it  forms  a 
useful  and  wholesome  food,  and  is  at  Vichy  regularly 
served  at  breakfast  to  the  invalids  who  are  taking  the 


Chap.  IV.]  Green  Vegetables.  85 

waters  there.  It  contains  a  large  proportion  of  water, 
85  to  88  per  cent.,  and  about  8  per  cent,  of  carbo- 
hydrates, including  a  variable  quantity  of  sugai',  1  per 
cent,  of  salts,  and  rather  more  than  1  per  cent,  of 
albuminates. 

The  parsnip  is  much  less  frequently  eaten  than 
the  carrot,  which  it  closely  resembles  in  food  properties 
and  composition,  containing  like  it  a  considerable 
amount  of  sugar. 

Tlie  turnip  is  one  of  the  cabbage  tribe.  It  is  a 
very  popular  vegetable,  and  the  roots  are  largely  cul- 
tivated as  food  for  cattle.  Its  nutritive  value  is  small, 
on  account  of  the  large  proportion  of  water,  91  per 
cent.,  it  cont-iins.  It  contains  about  6  per  cent,  of 
carbohydrates  (starch,  sugar,  etc.),  and  about  1  per 
cent,  of  nitrogenous  substances.  It  would  probably 
be  more  popular  as  a  vegetable  on  account  of  its 
agreeable  flavour  were  it  not  for  its  tendency  to  cause 
flatulence. 

Beetroot  i;i  a  most  valuable  vegetable.  It  is 
extensively  cultivated  as  food  for  cattle,  and  for  the 
extraction  of  luigar.  It  is  largely  employed  in  salads, 
alone  or  with  other  vegetables,  and  unless  tough  and 
stringy  is  not  indigestible.  It  contains  about  87  per 
cent,  of  water,  9  of  carbohydrates,  Ij^-  of  nitrogenous 
substances,  and  1  of  salts. 

The  radish  resembles  the  turnip  somewhat  in 
composition  and  flavour  ;  it  is,  however,  more  pungent, 
and  is  eaten  rather  for  its  agreeable  flavour  and  its 
anti-scorbutic  properties  than  as  a,  food. 

Salsify  is  rarely  eaten  in  England.  It  resembles 
the  parsnip  somewhat  in  taste,  and  is  a  wholesome 
vegetable. 

Oreen  vegetables.— The  various  green,  fresh, 
and  succulent  vegetables  that  are  commonly  regarded 
as  suitable  articles  of  food,  such  as  the  several  mem- 
bers of  the  cabbage  tribe,  spinach,  lettuce,  asparagus, 
and  others  which  will  I)e  presently  enumerated,  are 
valuable    not  so  much  on  account  of  the  nutritious 


86  Food  in  Health.  [Pani. 

principles  they  contain,  which  are  in  small  amount, 
as  on  account  of  the  important  inorganic  salts  they 
supply,  especially  the  salts  of  potash,  and  because  of 
the  agreeable  flavour  possessed  by  many,  and  the 
wholesome  variety  and  relish  they  give  to  our  food. 
Their  anti-scorbutic  properties  are  highly  important. 
They  contain  a  very  large  amount  of  water,  often  as 
much  or  more  than  90  per  cent.  The  amount  of 
nitrogenous  substances  they  contain  is  small,  varying 
from  about  \\  to  4  per  cent. 

They  contain  a  variety  of  non-nitrogenous  sub- 
stances, including  cellulose,  chlorophyll  (the  green 
colouring  matter),  small  quantities  of  sugar,  gum, 
pectin,  fat,  and  vegetable  acids.  Many  also  contain 
essential  oils  or  other  flavouring  matters,  which  impart 
to  them  agreeable  tastes  and  odours,  and  make  them 
useful  as  condiments. 

When  they  are  old  and  stringy  or  woody,  their 
cellulose  offers  gi-eat  resistance  to  digestion,  and  they 
are  quite  unsuited  to  persons  of  feeble  digestive 
powers.  On  the  other  hand,  the  indigestible  I'esidue  , 
left  by  all- green  vegetables  affords  a  useful  and  whole- 
some stimulus  to  intestinal  contraction,  and  promotes 
regular  action  of  the  bowels. 

By  well-known  arts  of  cultivation,  the  succulency 
and  digestibility  of  many  of  these  vegetables  are 
greatly  increased,  esi)ecially  by  j)artial  exclusion  of 
light,  and  their  value  as  articles  of  diet  is  thereby 
greatly  enhanced. 

The  cruciferous,  or  cabbage,  tribe,  is  remarkable 
for  the  number  of  edible  plants  it  contains.  The 
natural  order  of  the  Cruciferse  is  said  not  to  possess  a 
single  poisonous  plant,  a  botanical  fact  of  great  im- 
portance to  those  who  happen  to  be  in  search  of 
edible  vegetables  in  a  strange  or  unknown  country. 
Cabbages  (white  and  red),  greens,  savoys,  Brussels 
sprouts,  cauliflower,  and  broccoli  are  fainiliar  examples. 
These  contain  a  large  proportion  of  sulphur,  and 
therefore  give  rise  during  decomposition  to  a  very 
disagreeable  odour,  and  tend  to  occasion  flatulence. 


Chap.  IV.]  Green   Vegetables.  87 

Saiier-kraiit  is  a  preparation  of  cabbage  leaves, 
which  are  subject  to  pressure  between  layers  of  salt 
and  allowed  to  undergo  acid  fermentation. 

Cauliflo\%'er  and  broccoli  consist  of  the  in- 
Jlorescence  of  the  plant  altered  by  cultivation.  It  is 
one  of  the  most  delicate  and  most  digestible  of  the 
cabbage  tribe. 

Seakale^  which  is  grown  excluded  from  light 
and  thereby  blanched,  is  also  delicate,  nutritious,  and 
easy  of  digestion. 

Spinach  is  a  wholesome  and  popular  vegetable, 
and  when  properly  cooked — i.e.  made  into  a  puree — 
is  free  from  irritating  properties.  As  it  is,  however, 
almost  wholly  indigestible,  it  acts  as  a  useful  aperient, 
and  is  for  that  reason  prescribed  as  a  remedy  for 
habitual  constipation.  Hence  also  its  reputation  for 
"  clearing  the  complexion."  There  exists  a  very  old 
French  proverb  to  this,  effect : — 

"  Par  I'espinard  et  le  porreau, 
Florit  le  lys  clair  de  la  peau." 

Sorrel  is  used  largely  in  France,  much  in  the 
same  way  as  spinach  is  used  in  Great  Britain.  It  is 
peculiar  in  having  an  acid  taste,  due  to  the  presence 
of  acid  oxalates,  and  on  that  account  it  is  considered 
as  })rejudicial  to  those  who  have  any  tendency  to  gout 
or  gravel. 

Celery  is  esteemed  for  its  agreeable  aromatic 
flavour,  and  is  eaten  both  raw  and  cooked  ;  in  the 
latter  form  it  is  wholesome  and  digestible.  It  is  by 
some  i-egarded  as  aphrodisiac  as  well  as  carminative. 

It  also  has  a  popular  reputation  as  being  a  cure  for 
rheumatism  if  cooked  and  eaten  freely. 

The  gi'een  articiioke,  a  species  of  cultivated 
thistle,  is  of  little  importance  as  an  article  of  food  ;  it 
is  considered  rather  as  an  agreeable  delicacy,  easy  of 
digestion.  It  is  said  to  contain  some  tannin  as  well 
as  mucilaginous  substances. 

Asparagus.— This,    one    of    the    Liliacece,    is   a 


88  Food  in  Health.  [Pani. 

popular  and  delicate  vegetable.  It  contains  a  peculiar 
crystalline  principle,  asparagin^^Vxc^  possesses  diuretic 
properties,  and  imparts  a  peculiar  diagreeable  odour 
to  the  urine.  It  has  been  reputed  to  act  as  a  caidiac 
sedative,  and  to  quiet  palpitations ;  it  has  also  been 
credited  with  aphrodisiac  properties. 

Lietliice.  endive,  natercress,  mustard  and 
cress,  are  salad  vegetables,  and  are  generally  eaten 
raw.  They  are  cooling,  anti-scorbutic,  and  wholesome, 
and  easy  of  digestion  when  the  digestive  organs  are 
sound. 

The  onion  is  valuable  both  as  a  condiment  and  a 
vegetable.  In  the  young  green  state  it  is  added  to 
salads  to  give  them  pungency,  and  the  mature  bulb  is 
also  extensively  used  for  flavouring  purposes.  The 
larger  species  grown  in  hotter  countries,  as  in  Spain 
and  Portugal,  are  of  much  milder  flavour,  and  are 
eaten  as  an  ordinary  vegetable ;  they  are  wholesome 
and  slightly  laxative. 

The  vegetable  marrow,  although  of  delicate 
flavour  and  digestion,  has  very  little  nutritive  value 
on  account  of  the  very  large  proportion  of  water  it 
contains. 

The  tomato,  largely  used  in  salads  and  for  the 
preparation  of  soups  and  sauces,  is  refreshing  and 
appetising,  and  is  valuable  chiefly  for  its  pleasant 
acid  davour.  It  is  forbidden  by  many  physicians  to 
hU  those  who  have  a  tendency  to  gout  or  gravel,  on 
account  of  its  containing  oxalic  acid. 

The  cucumber  is  used  chiefly  as  a  salad,  and 
young  cucumbers  (gherkins)  are  pickled  in  vinegar. 

They  have  an  agreeable  refreshing  flavour,  but  the 
cucumber  eaten  raw  is  liable  to  cause  gastric  disturb- 
ance in  persons  of  feeble  digestion. 

The  following  tables  (after  Konig)  give  1st,  the 
average  composition  of  the  chief  succulent  roots  and 
green  vegetables ;  also  that  of  the  French  bean  when 
eaten  as  a  fresh  vegetable,  the  pods  and  seeds  together  ; 
and  2nd,  the  constituents  of  the  ash  of  certain  of 
these: — 


Chap.  IV.] 


Gkeen  Vegetables. 


89 


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9° 


Food  in  Health. 


[PartL 


Edible  fungi. — Many  species  of  fungi  are  suit- 
able for  food,  but  in  England  three  only  are  commonly 
eaten — namely,  the  inusliroom,  the  truffle,  and 
the  morelle. 

Their  chemical  composition  indicates  a  richness  in 
nutritive,  and  especially  in  nitrogenous  substances, 
which  should  render  them  of  considerable  value  as 
foods  were  they  ensy  of  digestion,  but  it  seems  doubt- 
ful if  they  are  utilised  in  the  alimentary  canal.  Some 
of  them  contain  mannite  and  grape  sugar  amongst 
their  non-nitrogenous  constituents. 

Mushrooms  are  largely  consumed  in  England,  but 
chiefly  on  account  of  their  agreeable  flavour ;  and 
they  are  eaten  either  alone  or  cooked  with  other  kinds 
of  food.  They  have  the  property  of  causing  toxic 
symptoms,  in  certain  persons,  in  the  form  of  severe 
gastro-intestinal  disturbance. 

The  morelle  is  usually  imported  from  the  Continent, 
and  is  employed  chiefly  for  flavouring  other  dishes. 

The  truffle  is  esteemed  a  great  delicacy,  and  is 
much  employed  in  cooking,  for  its  exquisite  flavour. 
The  black  variety  is  the  most  highly  valued,  and  those 
obtained  from  the  oak-forests  of  Perigord  in  France 
are  considered  of  the  choicest  flavour.  They  must  be 
regarded  as  very  indigestible  vegetables. 

The  following  is  the  chemical  composition  of  the 
mushroom,  truffle,  and  morelle  as  given  by  Konig.  The 
ash  is  particularly  rich  in  potash  and  phosphoric 
acid : — 


Water  

Nitrogenous  Substances 

Fat 

Gi-ape  Sugar  and  Mannite 

Other  non-Nitrogenous  Substances 

Woodv  Fibre  

Ash    ' 


900 
3-48 
0-24 
0-72 
3-9.5 
0-67 
0-94 


Chap.  IV.] 


Fruits. 


91 


Bauer  mentions  that  Iceland  moss  is  used  as  a 
food  in  the  Arctic  regions,  and  that  after  removal  of 
its  bitter  constituents  by  repeated  washings,  a  pleasant- 
tasting  bread  is  made  of  it,  which  has  been  recom- 
mended by  Senator  as  a  substitute  for  ordinary  bread 
in  diabetes. 


Fmits. — A  great  variety  of  fruits,  both  in  the 
fresh  and  dried  state,  are  consumed  as  articles  of  food 
or  as  flavouring  agents  and  luxuries. 

The  following  are  the  principal  varieties  made  use 
of  in  Great  Britain,  some  being  of  native  growth  and 
others  imported : — 

1.  The  apple,  pear,  and  quince. 

2.  The  orange,  lemon,  lime,  and  shaddock. 

3.  The  plum,  peach,  apricot,  cherry,  olive,  date 
(stone  fruits). 

4.  The  grape,  gooseberry,  currant,  cranberry,  bar- 
berry. 

5.  The  strawberry,  raspberry,  blackberry,  mul- 
berry. 

6.  Melon,  pine-apple,  fig,  banana. 

The  following  table  gives  the  average  composi- 
tion of  some  of  the  most  important  of  these  (after 
Bauer) : — 


Apple. 

Pear. 

Peach. 

Grape. 

Straw, 
berry. 

Cur- 
rants. 

Orange 
(pulp 
only). 

Water 

83-58 

8303 

8003 

78-18 

87-66 

84-77 

89-01 

Nitrogenous    \ 
Matters  ... 

0-39 

0-36 

0-65 

0-59 

1-07 

0-51 

0-73 

Free  Acids . . . 

0-84 

0-20 

0-92 

0-79 

0-93 

215 

2-44 

Sugar 

7-73 

8-26 

4-48 

14-36 

6-28 

6-38 

4-59 

Other  non-      \ 

Nitrogenous  > 

5-17 

3-64 

7.17 

1-96 

0-48 

0-90 

0-95 

Matters     ...  ) 

Cellulose  and  ] 
Kernel 

1-98 

4-30 

606 

3-60 

2-32 

4-57 

1-79 

Ash 

0-31 

0-31 

069 

0-53 

0-81 

0-72 

0-49 

92 


Food  in  Health. 


(Part  I. 


The  following  gives   the   composition   of  certain 
dried  fruits : — 


Apple. 

Cherry. 

Raisin. 

Fig. 

Water 

27-95 

49-88 

32-02 

31-20 

Nitrogenous  Matters    .. 

1-28 

2-07 

2-42 

4-01 

Fat        

0-82 

0  30 

0-49 

1-44 

Free  Acid         

3-60 





1-21 

Sugar    

42-83 

31-22 

54-26 

49-79 

Other  non-Nitrogenouj  \ 
Matters         ...          ..  j 

17-0 

14-29 

7-48 

4-51 

Cellulose  and  Seeds     ... 

4-95 

0-61 

1-72 

4-98 

Ash        

1-57 

i-63 

1-21 

2-86 

The  analysis  of  the  ash  shows  these  fruits  generally 
to  be  particularly  rich  in  potash  salts.  The  apple  and 
the  strawberry  are  rich  also  in  soda  salts,  especially  the 
strawberry.  They  also  contain  salts  of  linae,  magnesia, 
and  iron. 

It  will  be  seen  from  the  above  tables  that  these 
fruits  possess  but  a  low  nutritive  value,  as  they  con- 
tain a  very  large  proportion  of  water,  and  of  their 
solids  only  a  very  small  proportion  consists  of  nitro- 
genous matters.  Their  chief  food  value  is  in  the 
sugar  which  they  contain.  This,  in  some,  is  consider- 
able. They  also  contain  important  salts  of  vegetable 
acids  (malates,  citrates,  tarti;§tc»)  as  well  as  some  free 
acid. 

They  therefore  possess  valuable  antiscorbutic  pro- 
perties. As  their  salts  are  chiefly  combinations  of 
vegetable  acids  with  alkalies,  and  as  these  become  con- 
verted into  carbonates  in  the  system,  they  impart 
alkalinity  to  the  urine,  and  they  are,  on  that  account, 
valuable  in  gouty  states  with  a  tendency  to  the  depo- 
sition of  acid  urates. 

Many  contain  small  quantities  of  fat,  and  waxy 
and  colouring  matters.  Their  agreeable  aroma  is  due 
to  the  presence  of  essential  oils  and  compound  ethers. 
They   all   contain    varying   amounts   of   indigestible 


Chap.  IV.]  Fruits.  93 

cellulose  and  pectin  or  vegetable  jelly.  Malic  acid  is 
found  in  apples,  pears,  peaches,  apricots,  gooseberries, 
arid  currants ;  tartaric  acid  in  grapes ;  and  citric  acid 
in  lemons,  oranges,  etc. 

When  taken  in  moderate  quantity  these  fruits  are 
useful  additions  to  the  dietary  :  they  are  cooling  and 
refreshing,  of  agreeable  flavour,  and  tend  to  promote 
intestinal  action,  and  to  correct  tendencies  to  constipa- 
tion. Taken  in  excess,  or  when  immature,  or  over- 
ripe, they  are  apt  to  set  up  gastro-intestinal  irritation, 
often  of  a  severe  form. 

Most  of  these  fruits  are  so  well  known  that  any 
detailed  descriptions  of  them  would  be  redundant. 

Tho  apple  when  cooked,  and  of  good  quality,  is 
easy  of  digestion,  cooling,  and  slightly  laxative. 

Pears  of  the  best  quality,  when  ripe,  are  better 
suited  for  being  eaten  raw  than  apples,  as  their  flesh 
is  soft  and  "melts  in  the  mouth." 

Orang^cs  are  especially  valuable  for  invalids; 
when  ripe  and  well  selected  they  are  pleasant  and 
refreshing,  and  very  grateful  for  allaying  thirst  in 
feverish  conditions. 

The  lemon  and  its  congeners  the  lime  and  shad- 
docR  are  important  as  yielding  a  useful  anti-scorbutic 
juice,  and  for  giving  an  agreeable  pungency  and  flavour 
to  insipid  and  tasteless  foods. 

Plums  should  be  avoided  in  tlie  unripe  and  over- 
ripe states,  and  they  are  more  apt  than  other  fruits  to 
prove  indigestible  and  irritating,  and  to  cause  diar- 
rhcBa.  Dried  plums  (pniiics)  are  often  judiciously 
added  to  the  daily  dietary  to  remedy  habitual  consti- 
pation. 

Peaches  and  iiectai-ines  are  paiticularly  deli- 
cate-flavoured and  refreshing.  Owing  to  the  small 
quantity  of  sugar  they  contain,  and  their  soft  and 
delicate  flesh  (when  ripe)  they  are  well  suited  to  the 
gouty  and  diabetic. 

Cui-i-ants,  g[ooseberries,  bilberries,  and 
raspberries  are  remarkable  for  the  amount  oifree 
acid  they  contain,  which  makes  them  veiy  refi'e.shing 


94  Food  in  Health.  [Pani. 

and  their  juices  form  an  agreeable  addition  to  effer- 
vescing water.  The  uiul  berry  is  also  very  refreshing, 
and  has  slightly  laxative  properties. 

The  sfraivberry  is  one  of  the  most  popular  of 
fruits,  and  is  very  wholesome  when  taken  in  modera- 
tion. It  is  considered  to  be  a  useful  food  for  the 
gouty  on  account  of  its  richness  in  alkaline  salts 
(potash,  soda,  and  lime)  and  its  cooling,  diuretic,  and 
laxative  qualities.  There  are  some  physicians  who 
forbid  this  fruit  to  the  gouty,  but  it  is  only  in  a  few 
rare  cases  that  it  is  found  to  disagree.  French 
authoi-s  maintain  that  its  flavour  is  enhanced  by  the 
addition  of  some  acid  juice,  such  as  orange  or  lemon 
juice,  or  a  few  drops  of  good  vinegar. 

The  gi'iipc  is  a  very  important  fruit,  on  account  of 
its  richness  in  sugar,  both  in  the  fresh  and  dried 
(raisins)  form.  It  is  very  digestible  when  fully  ripe 
and  most  acceptable  to  invalids.  Its  properties  will 
be  fully  discussed  in  connection  with  the  grape  cure. 

The  melon  is  perhaps  the  most  watery  of  all  the 
fruits,  containing,  as  it  does,  more  than  95  per  cent, 
of  water ;  notwithstanding  this  it  is  apt  to  prove 
very  indigestible,  and  to  give  rise  to  gastric  disturb- 
ance. 

Figs  both  in  the  green  and  dry  state  contain 
much  sugar,  and  also  a  rather  large  proportion  of 
nitrogenous  matters,  so  that  they  are  more  nutritious 
than  most  fruits  ;  in  large  quantities  they  are  apt  to 
prove  aperient. 

The  date  is  also  a  highly  nutritious  fruit,  and 
forms  an  iuiportant  food  for  the  Arabs. 

The  banana  and  plantain  are  also  nutritious 
fruits,  as  they  contain  much  sugar  and  a  certain  pro- 
portion of  nitrogenous  matters. 

Saccharine  Substances. 

Grape  sugar  is  largely  present  in  all  sweet  fruits, 
and  all  starchy  foods  in  the  processes  of  digestion 
become  converted  into  grape  sugar  or  into   maltose 


y 


Chap.  IV.]  Saccharine  Substances.  95 

before  assimilation.  A  form  of  sugar,  lactose,  is  also 
present  in  considerable  quantity  in  that  typical  food 
— milk.  But  the  importance  of  sugar  as  an  aliment- 
ary principle  has  already  been  shown,  and  it  is 
more  in  its  character  as  a  flavouring  agent,  and 
as  a  pleasing  addition  to  food,  that  we  must  now 
regard  it.  Sugar  is  not  only  a  food,  it  is  also  a 
very  largely  adopted  luxury,  on  account  of  its  agree- 
ably sweet  taste.  As  a  food,  owing  to  its  ready  solu- 
bility, it  needs  no  previous  digestion ;  indeed,  grape 
sugar  has  been  termed  a  "  pre-digested  "  carbohydrate. 
It  is,  however,  especially  when  mixed  with  other  food, 
apt  to  give  rise  to  acidity  and  flatulence  in  some  dys 
peptic  persons.  It  appears,  in  such  cases,  to  promote 
acid  fermentation  in  the  alioientary  canal. 

Sugar  is  very  largely  used  in  the  preservation  of 
fruit,  etc.,  on  account  of  its  antiseptic  properties. 

Caiic,  or  crystalline,  sugar  is  the  kind  generally 
used  for  addition  to  other  foods.  It  is  obtained  chiefly 
from  the  sugar-cane  or  from  beetroot;  other  plants, 
however,  yield  it,  as  certain  species  of  maple,  etc. 

Cane  sugar,  after  extraction,  usually  undergoes  an 
elaborate  refining  process,  by  means  of  which  the  im- 
purities are  separated  and  nearly  pure  cane  sugar  is 
produced. 

Orape  sugar  or  glucose  crystallises  less  readily, 
and  is  inferior  in  sweetening  power.  It  is  usually 
prepai'ed  from  starch. 

Molasses  and  treacle  are  more  or  less  fluid 
residiies  left  after  separation  of  the  crystallisable  sub- 
stances in  the  preparation  of  cane  sugar. 

Honey  is  a  concentrated  solution  of  sugar  mixed 
with  a  certain  amount  of  wax,  gum,  and  odorous  and 
colouring  substances.  It  contains  a  crystallisable  and 
a  non-crystaliisable  sugar  —  the  former  resembles 
glucose. 

Before  the  disco^^^ery  of  sugar,  honey  used  to  be 
largely  employed  as  a  sweetening  agent,  and  it  has  the 
same  food  properties  and  value  as  sugar. 


96 


CHAPTER    V. 

BEVERAGES. 

Wafer. — All  beverages  contain  water  in  certain 
proportions,  and,  as  may  be  seen  by  reference  to  the 
various  analyses  of  solid  foods,  water  enters  also 
largely  into  their  composition.  The  human  body 
is  itself  composed  to  a  great  extent  of  water, 
nearly  60  per  cent.  Everything  that  is  carried 
into  the  circulating  fluids  of  the  body,  or  that  is 
eliminated  from  them,  is  conveyed  by  the  agency  of 
water.  As  a  solvent  it  is  indispensable  in  all  tlie 
functional  activities  of  the  body.  The  consumption 
daily  of  a  certain  amount  of  water  is  thus  an  absolute 
necessity.  Much  of  this  is,  of  course,  taken  into  the 
body  combined  with  the  solids  of  the  food,  but  a 
certain  quantity  is  required  in  the  fluid  form,  and 
this  is  supplied  by  our  various  beverages.  One  of  the 
best  ways  of  supplying  water  to  the  body  is  by  drink- 
ing it  in  its  pure  st^ite,  when  its  important  solvent 
properties  can  be  completely  utilised. 

The  quantity  of  water  needed  daily  must  neces- 
sarily depend  on  the  amount  of  the  loss  of  this  fluid 
which  takes  place  by  the  lungs,  skin,  and  kidneys, 
and  this  will  be  largely  determined  by  the  amount  of 
work  or  exercise  performed  by  the  body,  as  well  as  by 
the  temperature  to  which  it  is  exposed.  The  quantity 
required  daily  must  also  vary  much  with  the  kind  of 
food  which  enters  into  our  diet ;  the  drier  the  solids 
we  eat  the  more  water  we  shall  need,  the  more  succu- 
lent they  are  the  less  we  shall  require.  It  has  been 
estimated  that  on  an  average  an  adult  will  require 
daily  from  2^  to  4  pints  of  water,  or  some  beverage 
consisting  almost  entirely  of  water. 


Chap,  v.]  Beverages  : —  Wa  tee.  97 

The  purer  the  water  obtained  for  drinking  purposes 
the  better;  most,  however,  of  so-called  drinking  waters, 
as  derived  either  directly  from  springs  or  from  wells 
and  rivers,  contain  dissolved  gases  and  mineral  sub- 
stances. These  often  improve  the  flavour  of  the 
water,  and  give  it  a  pleasant  freshness,  but  an  excess 
of  mineral  ingredients  detracts  seriously  from  its 
solvent  properties. 

Rain  water  is  the  purest  form  of  natural  water, 
and  resembles  distilled  water,  except  that  it  contains 
whatever  soluble  constituents  exist  in  the  atmosphere 
through  which  it  has  fallen,  so  that  traces  of  ammonia 
and  nitnc  acid  are  generally  to  be  found  in  it.  If 
used  for  drinking  purposes  it  needs  to  be  collected 
with  great  care,  as  it  is  apt  to  dissolve  any  soluble 
substances  with  which  it  comes  in  contact.  It  must 
therefore  not  be  received  in  leaden  cisterns. 

Distilled  water  is  now  largely  used  at  sea,  as  most 
passenger  ships  are  provided  with  condensing  appa- 
ratus.    When  aerated  it  is  a  pleasant  beverage. 

Water  used  for  drinking  purposes  should,  of 
course,  be  freed  from  all  organic  impurity;  most 
spring  waters,  however,  although  quite  pure  in  this 
sense,  contain  a  variable  quantity  of  mineral  con- 
stituents, especially  of  salts  of  lime,  and  these,  if 
abundant,  may  detract  from  the  value  of  the  water 
for  drinking  and  domestic  purposes.  Such  water 
may  cause  digestive  disturbance,  or  promote  con- 
stipation, or  may  intensify  any  tendency  that  exists 
to  calculous  disorders.  Boiling  the  water  has  the 
effect  of  greatly  diminishing  the  hardness  due  to  the 
presence  of  earthy  carbonates,  and  so  rendering  it 
more  suitable  as  a  beverage.  This  it  does  by  driving 
off  the  carbonic  acid,  which  is  always  present  in 
spring  water,  and  which  keeps  these  carbonates  in 
solution  ;  after  boiling  they  are  in  pai-t  precipitated. 
Boiling  has  the  further  advantage  of  destroying  most 
organic  germs. 

Water  which  is  not  pure  may  be  rendered  purer 
by  suitable  filtration. 
H 


98  Food  in  Health.  [Parti. 

A  full  account  of  water  filtration  and  filters  will 
be  found  in  the  eighth  edition  of  Parker's  "  Hygiene," 
edited  by  Professor  Notter.  Professor  Notter  points 
out  that  all  filters  require  more  or  less  frequent 
cleaning.  He  mentions  that  Maignen's  "  Filtre 
Rapide  "  is  much  used  in  the  Sei-vices.* 

Water,  then,  is  an  indispensable  beverage;  as  a 
solvent  agent  it  is  needed  in  all  the  important  chemical 
changes  connected  with  nutrition  ;  it  is  a  valuable 
diui'etic  ;  it  is  absorbed  rapidly  and  eliminated  rapidly. 
It  has  been  justly  said  that  the  use  of  an  abundance 
of  water  as  a  bevei'age  promotes  a  sort  of  "  washing  " 
of  the  various  tissues  of  the  body ;  that  when  taken 
at  the  end  of  stomach  digestion  it  carries  undigested 
substances  out  of  the  stomach  into  tlie  small  intestine. 
It  has  been  contended  by  some  that  the  mineral 
substances  found  in  spring  and  river  water  may 
usefully  supply  some  of  the  salts  required  for  the 
construction  and  repair  of  the  tissues,  and  that  the 
existence  of  lime  salts  in  such  water  is  not  altogether 
disadvantageous.  This  may  possibly  be  the  case  with 
young  growing  subjects. 

Iced  water,  taken  in  small  quantities,  is  refreshing 
and  cooling,  and  stimulates  the  digestive  functions, 
but  it  is  injurious  when  taken  in  great  amount.  Of 
the  useful  refrigerating  action  of  cold  water  as  a 
beverage  in  acute  diseases  we  shall  speak  hereafter. 

Tea,  coflee.  and  cocoa. — These  aromatic  and 
popular  beverages,  a1  though  diffex'ing  considerably  from 
one  another  in  their  common  physical  characters,  agree 
in  containing  alkaloids  which  are  either  identical  or 
'  closely  re'ated.  Tea  and  cofTee  contain  alkaloids,  (hein 
and  cajtin,  which  are  identical,  and  cocoa  contains  an 
alkaloid,  t/ieoLromin,  which  is  closely  allied  to  these. 

There  is  a  great  resemblance  in  the  general  effects 
of  tea  and  coffee,  as  might  be  concluded  from  the 
fact  that  they  contain  the  same  alkaloid,  while  the 

*The  "  Pasteur  Chamberland  "  filter  is  one  of  the  most  per- 
fect, and  completely  separates  micro-organisms.  The  filtering 
medium  is  a  solid  cylinder  of  porcelain. 


Chap,  v.i  Beverages: — Tea.  99 

difference  in  their  effects  is  probably  due  to  the 
different  aromatic  principles  or  essential  oils  they 
contain,  and  to  the  greater  amount  of  tannin  in  tea. 

Cocoa,  however,  differs  greatly  in  its  properties  and 
effects,  as  well  as  in  its  composition,  from  tea  and 
coffee.  We  shall  consider  each  of  these  beverages 
separately ;  and  first  with  regard  to 

Tea. — A  great  many  varieties  of  tea  are  now  im- 
ported into  Britain  from  Indian  and  Ceylon,  besides 
the  older  kinds  grown  in  China. 

The  average  composition  of  dry  tea  is  stated  by 
Bauor  to  be  as  follows  : — 

Thein 1-35 

Other  Nitrogenous  Combinati'.ins  ...  9 '44 

Non-nitrogenous  Extractives         ...  19 '20 

Ash      3*65 

Total  of  Matters  soluble  in  Water. . .       33  '64  per  cent. 

In  Parkes's  "  Manual  "  the  composition  of  dry  tea 
is  thus  given  : — "  About  1*8  per  cent,  of  thein,  2-6  of 
albumen,  9 '7  of  dextrin,  22  of  cellulose,  15  0  of  tannin, 
20  0  of  extractives,  5'-4  of  ash,  as  well  as  other  matters, 
such  as  oil,  wax,  and  resin."  Its  aroma  is  due  to  a 
volatile  oil. 

The  thein  is  combined  with  tannic  acid.  Some  of 
the  best  teas  yield  a  much  larger  proportion  of  thein 
than  others.  Green  tea  is  somewhat  richer  than  hlack 
in  thein,  ethereal  oil,  and  tannic  acid,  and,  indeed,  in 
all  the  soluble  constituents,  by  about  5  per  cent. 

The  ash  contains  potash,  soda,  magnesia,  phos- 
phoric acid,  chlorine,  carbonate  acid,  iron,  and  silica. 
The  principal  constituents,  and  those  which  give  it  its 
characteristic  properties,  are  thein,  an  aromatic  volatile 
oil,  and  tannic  acid ;  of  the  last  it  contains,  as  stated 
above,  about  1 5  per  cent. 

The  difference  between  green  and  hlack  tea  is 
simply  dependent  on  differences  in  the  time  of  gather- 
ing the  leaves,  and  their  mode  of  treatment.  The 
green  is  prepared  from  younger  leaves,  which  are 
H  2 


lOO 


Food  in  Health. 


[Part  I. 


roasted  in  pans  soon  after  gathering.  Of  China  teas, 
Young  Hyson  is  considered  the  finest  kind  of  green, 
and  Souchong  and  Pekoe  of  hlack  tea.  Some  teas  are 
"  scented  "  in  China  by  mixing  the  leaves  with  odorous 
flowers,  such  as  orange-blossom,  jasmine,  roses,  etc. 

Both  thein  and  tannin  are  soluble  in  boiling  water, 
and  when  the  tea  is  infused  they  are  dissolved  out 
together ;  but  some  Indian  teas  if  long  infused  con- 
tinue to  give  out  tannin  after  all  the  thein  has  been 
exhausted. 

Indian  and  Ceylon  teas  yield  much  more  tannin 
in  their  infusion  than  good  China  tea.  This  is  well 
shown  in  the  following  table  {Professor  Dittmar), 
which  gives  the  results  of  infusing  these  three.varieties 
of  tea  for  five  and  ten  minutes  respectively  : — 


Five  Minutes. 

Ten  Minutes. 

Thein. 

Tannin. 

Thein. 

Tannin. 

China 

Ceylon 

Indian 

2  •58 
3-15 
3-63 

3-06 
5-87 
6-77 

2-79 
3-29 
3-73 

3-78 
7-30 
8  09 

It  appears  that  Indian  tea,  when  infused  for  ten 
minutes,  yields  more  than  twice  as  much  tannin  as 
China  tea ;  and  with  China  tea  there  is  but  little 
difference  between  an  infusion  of  five  minutes  and  one 
of  ten  minutes.  This  result  is  therefore  strikingly 
corroborative  of  Sir  William  Roberts's  statement,  that 
owing  to  the  great  solubility  of  tannin  in  hot  water 
it  is  impossible  to  avoid  the  extraction  of  a  great 
amount  of  tannin,  even  by  the  shortest  infusion.  It 
is  only  in  the  case  of  a  tea  so  rich  in  tannin  as  some 
of  the  Indian  tea.s,  that  prolonged  infusion  makes  any 
considerable  difference  in  the  amount  of  tannin 
extracted. 

Indian  teas,  on  account  of  the  great  amount  of 


Chap,  v.]  Beverages  : — Tea.  ioi 

tannin  t-hey  contain,  are  much  more  prone  to  cause 
gastric  and  nervous  disorders  in  sensitive  persons 
than  the  best  China  teas. 

In  making  an  infusion  of  tea  the  water  should  be 
boiHng ;  for  deHcacy  of  flavour  it  should  be  neither 
too  hard  nor  too  soft,  but  for  economical  purposes  the 
softer  the  water  the  better. 

Parkes  suggests  that  as  water  containing  much 
lime  or  iron  will  not  make  good  tea,  such  water  should 
be  well  boiled  for  fifteen  to  twenty  minutes  with  a 
little  carbonate  of  soda  before  it  is  used  for  making  tea, 
and  Sir  William  Roberts  also  advocates  the  addition 
of  carbonate  of  soda  to  tea  for  other  reasons,  as  will 
be  immediately  mentioned. 

Soft  water  extracts  more  of  the  s<jluble  principles 
of  the  leaves,  and  makes  a  darker  infusion,  but  some 
think  that  the  infusion  is,  on  that  account,  of  less  deli- 
cate flavoui".  The  infusion  should  not  be  for  more 
than  three  or  four  minutes.  Longtir  infusion  lessens 
the  aroma  and  extracts  too  much  of  the  soluble  matters, 
thereby  diminishing  the  deUcacy  of  flavour  of  the 
beverage. 

As  to  the  effects  of  tea  as  an  article  of  diet  much 
difference  of  opinion  exists,  and  especially  as  to  the 
relative  value  of  tea  and  coffee.  It  should  be  recog- 
nised that  there  often  exist  great  individual  pecu- 
liarities with  regard  to  the  effects  of  these  beverages, 
and  hence  the  conflict  of  opinion  on  this  point. 

Tea  appears  to  act  as  a  stimulant  and  restorative 
to  the  nervous  system.  It  removes  fatigue,  rouses 
and  clears  the  mind,  and  promotes  intellectual  energy. 

It  diminishes  the  tendency  to  sleep,  and  this  effect 
may  be  carried  to  the  extent  of  producing  sleeplessness. 
When  taken,  as  it  usually  is,  hot,  the  warmth  of  the 
infusion  no  doubt  aids  its  stimulating  influence.  It 
increases  the  action  of  the  skin,  and  has  been  said  to 
cause  constipation,  but  it  certainly,  at  times,  appears 
to  have  the  opposite  effect,  and  a  cup  of  hot  tea  will 
often  accelerate  the  action  of  aperients.  It  deadens 
the  sensation  of  hunger,  and  increases  the  power  of 


102  Food  in  Health.  [Parti. 

fasting.  It  will  cool  the  body  wlien  liot — probably 
by  promoting  the  action  of  tlie  skin — and  it  warms  the 
body  when  cold.  It  will  often  relieve  headache,  and 
proves  a  useful  antidote  to  alcoholic  intoxication,  and 
especially  to  that  mental  torpor  which  even  small 
quantities  of  alcohol  will  produce  in  certain  persons. 
Green  tea  possesses  more  active  properties  than  black, 
and  is  more  likely  to  be  over-exciting  to  the  nervous 
system. 

There  can  be  no  doubt  that  for  most  persons  tea, 
taken  in  moderation,  proves  an  agreeable,  refreshing, 
and  wholesome  beverage.  It  has  been  found  a  most 
useful  article  of  diet  for  soldiers,  increasing  remarkably 
the  power  of  enduring  great  fatigue,  especially  in  hot 
climates.  When  milk  and  sugar  arc  added  to  tea  it 
becomes  a  nutritious  and  useful  food. 

On  the  other  hand,  it  is  quite  certain  that  tea 
taken  in  excess,  and  in  some  constitutions,  may  be- 
come very  injurious.  It  will  not  infrequently  excite 
and  maintain  most  troublesome  gastric  catarrh,  the 
only  remed}'  for  which  is  an  entire  abstinence  from 
tea  for  a  considerable  period.  It  is  often  also  the 
cause  of  troublesome  cai'diac  palpitations,  together 
with  muscular  tremors,  and  general  nervous  agitation. 
We  have  noticed  that  tea  will  often  commence  some- 
what suddenly  to  disagree  with  a  person,  and  excite 
dyspeptic  symptoms,  coincidently  with  the  occurrence 
of  nervous  worry,  and  that  after  the  cause  of  nervous 
anxiety  has  passed  away  tea  may  again  be  taken,  in 
moderation,  with  impunity.  In  irritable  states  of  the 
stomach  tea  is  also  apt  to  disagree,  especially  if  the 
coarser  teas  containing  much  tannin  are  taken  ;  these, 
when  taken  in  large  quantity  during  or  too  soon  after 
a  meal,  will  disturb,  and  often  seriously  hinder,  the 
digestive  process. 

The  ordinary  strength  of  tea,  according  to  Sir 
W.  Roberts,*  is  4  to  5  per  cent.,  "that  is,  four  or 
five  parts  of  the  dry  leaf  to  a  hundred  parts  of  boiling 
■water.     Strong  tea  runs  up  to  about  7  per  cent.,  and 

•  "  Lectures  on  Dict>itics  and  Dyspepsia." 


Chap,  v.]  Beverages  : — Coffee.  103 

weak  tea  goes  down  to  2  per  cent."  This  excellent 
observer  found  that  tea  exerted  an  inhibitory  or  re- 
tarding effect  on  salivary  and  peptic  digestion,  and  he 
concludes  that  this  effect  is  due  to  the  influence  of  the 
tannin  it  contains.  He  points  out  that  this  cannot  be 
avoided  by  brief  instead  of  protracted  infusion  :  "  Tea 
infused  for  two  minutes  was  not  found  sensibly  inferior 
in  its  retarding  power  on  salivary  digestion  to  tea  in- 
fused for  thirty  minutes."  The  best  way  to  mininiise 
the  inhibitory  eftect  of  tea  on  digestion  is  to  make  it 
very  weak  and  use  it  very  sparingly,  and  to  drink  it 
after  and  not  with  a  meal.  Adding  a  little  carbonate 
of  soda — 10  grains  to  1  ounce  of  the  dry  tea-leaf — had 
the  etiect  of  entirely  removing  this  retarding  efiect  on 
digestion. 

Collee. — Coffee  is  an  agreeable  aromatic  beverage 
prepared  from  the  seeds,  after  they  have  been 
roasted,  found  within  the  fruit  of  the  Coffea 
arabica. 

The  choicest  coffee  is  Mocha  or  Arabian  coffee.  It 
was  introduced  into  Europe  in  the  seventeenth  century, 
about  the  same  time  that  tea  was  also  introduced.  In 
roasting,  the  coffee  berries  are  exposed  to  a  temperature 
of  200°  Cent,  or  more ;  during  the  process  they  assume 
a  dark  brown  colour,  the  sugar  in  the  berry  is  converted 
into  caramel,  and  volatile  aromatic  empyreumatic  pro- 
ducts are  developed  which  give  to  colJ'ee  its  aroma. 
At  the  same  time  certain  gases  are  formed  which  swell 
up  the  seeds,  so  that  they  increase  in  bulk  while  they 
lose  in  weight. 

Coflee  should  be  roasted  only  a  short  time  before 
being  used,  as  owing  to  the  volatile  nature  of  the  aroma 
it  rapidly  deteriorates  by  keeping ;  for  the  same  reason 
the  roasted  berries  should  not  be  ground  till  imme- 
diately before  the  infusion  is  made. 

The  composition  of  unroasted  coffee  is  stated  by 
Parkes  to  be  34  per  cent,  of  cellulose,  10  to  13  per 
cent,  of  fat,  15"5  per  cent,  of  sugar,  dextrin,  and 
vegetable  acid,  and  10  per  cent,  of  legumin,  also  a 
solid  acid,    small  quantities  of  aromatic  oil,  and  the 


104  Food  in  Health.  [Pani. 

alkaloid  caffein.     The  chief  ingredients  of  the  ash  are 
potash  and  phosphoric  acid. 

According  to  Konig,  21  to  37  per  cent,  of  solids 
are  extracted  from  roasted  cofleo  by  infusion  ;  or  on 
an  average — 

Caffein           ,..  1-74 

Oil       5-18                       , 

Non-nitrogenous  Extractives          ..  14 -02                   r^ 

Ash 4-06 

Total  of  Matters  soluble  in  Water...         25-5  per  cent. 

The  chief  constituents,  then,  of  coffee  are  a  volatile 
oil,  developed  by  roasting,  to  which  it  owes  its  aroma ; 
caffeo-tannic  and  cafleic  acids ;  and  caffein,  an  alkaloid 
identical  with  thein. 

It  has  been  suggested  that  the  ethereal  oils  de- 
veloped during  the  roasting  of  coffee  are  more  con- 
cerned than  the  caffein  it  contains  in  imparting  to  it 
its  characteristic  properties. 

It  is  a  curious  fact  that  in  Europe  we  make  an 
infusion  of  coffee,  in  the  East  they  make  a  decoc- 
tion ;  the  latter,  Dujardin-Beaumetz  says,  preserves  its 
nutritive  and  tonic  properties,  while  it  gets  rid  of 
its  exciting  ones. 

The  value  of  coffee,  as  a  beverage,  is  greatly  de- 
pendent on  the  care  and  skill  manifested  in  its 
preparation. 

Coffee  should  be  made  perfectly  fresh,  from  freshly 
ground  and  freshly  roasted  seeds :  as  all  the  soluble 
substances  are  not  extracted  by  infusing  alone,  it  is 
desirable,  on  economical  grounds,  that  a  mixed  infusion 
and  decoction  should  be  made  in  the  following  man- 
ner : — After  first  preparing  an  infusion  by  passing 
boiling  water  over  the  coffee,  the  grounds  left  should 
be  boiled  in  more  water,  and  the  boiling  decoction 
thus  obtained  should  be  poured  over  another  portion 
of  freshly  ground  coffee ;  this,  in  its  turn,  is  also  boiled 
with  more  water,  to  be  used  again  with  fresh  coffee  in 
the  same  manner,  and  so  on.     By  this  method  all  the 


Chnp.  v.]  Beverages  '.-^Coffee.  105 

soluble  matters  in  the  coffee  are  extracted,  and  none 
of  the  aroma  is  needlessly  dissipated. 

The  effects  of  coffee  on  the  system  are  those  of  a 
decided  stimulant  to  the  nervous  centres.  It  has 
been  termed  in  France  UTie  hoisson  intellectuelle, 
on  account  of  its  stiumlating  action  on  the  brain. 
I(i  lessens  the  need  for  sleep  after  exertion,  and 
diminishes  the  sense  of  fatigue ;  indeed,  it  would 
appear  to  have  the  power  of  augmenting  the  functional 
activity  of  the  muscles.  It  has  also  a  decidedly 
stimulating  effect  on  the  heart ;  in  small  quantities  it 
quickens  its  action,  but  in  large  quantities  it  slows  it, 
and  when  taken  in  excessive  amount  it  will  often  sen- 
sibly disturb  the  rhythm  of  this  organ  and  cause  in- 
termission.* It  increases  the  seci'ctiun  of  the  kidneys 
and  of  the  skin,  and  in  some  persons  it  will  stimulate 
the  peristaltic  movement  of  the  intestine,  and  so  act 
as  an  aperient. 

It  will  sometimes  disturb  the  digestion  in  dyspeptic 
persons,  and  give  rise  to  heartburn,  anJ  this  is  more 
likely  to  occur  when  very  strong  coffee  is  taken  imme- 
diately after  a  full  meal.  Other  toxic  symptotus 
occasionally  occur  from  taking  coffee  in  excess,  or  in 
too  strong  infusion,  such  as  muscular  tremor,  nfcrvcus 
anxiety  and  dread  of  impending  danger,  as  well  as 
palpitation,  cardiac  in te amissions,  and  an  indefinite; 
uncomfortable  feeling  referred  to  the  cardiac  region. 

Although  coffee  can  exert  no  direct  nutritive  action 
on  the  system,  and  it  has  been  shown  that  its  use  tends 
to  increase  rather  than  diminish  (as  had  been  stated) 
the  excretion  of  urea,  yet  its  influence  in  sustaining 
the  human  body  under  fatigue  and  privation  is  very 
remarkable.  Parkes  bears  strong  testimony  to  its 
great  value  in  the  diet  of  the  soldier  :  "  Not  only  is  it 
invigorating  without  producing  subsequent  collapse, 
but  the  hot  infusion  is  almost  equally  serviceable 
against  both  cold  and  heat ;  in  the  one  case  the 
warmth  of  the  infusion,  in  the  other  the  action  on  the 

*  The  author  has  seen  several  instances  of  this  toxic  effect  of 
coffee  when  taken  inadvertently  in  excess. 


io6  Food 'IN  Health.  [tarti. 

skin,  being  useful,  while  in  both  cases  the  nervous 
stimulation  is  very  desirable."  It  has  been  said  to 
afford  some  protection  against  malaria. 

When  coffee  is  taken,  as  it  usually  is,  together 
with  milk  and  sugar,  as  cafe  cm  lait,  it  then  contains 
a  considerable  amount  of  nutritive  substances,  and 
forms  a  highly  sustaining  food. 

The  valuable  properties  possessed  by  coffee  are 
occasionally  utilised  in  the  treatment  of  disease ;  as 
an  antidote,  for  instance,  in  opium  poisoning  and 
alcoholic  intoxication.  It  is  also  given  as  a  cardiac 
tonic  in  heart  disease,  as  a  diuretic  in  dropsies  and 
urinaiy  disorders,  and  as  a  nervine  in  migrain  and 
asthma. 

Sir  W.  Roberts's  experiments  showed  that  coffee 
exerted  very  little  retarding  influence  on  salivary 
digestion,  as  compared  with  tea,  and  this  he  accounted 
for  by  the  fact  that  in  coffee  tannin  "is  replaced  by  a 
modification  of  that  substance  called  caffeo-tannic 
acid."  Coffee,  however,  was  found  to  exercise  a 
greater  retarding  influence  on  stomach  digestion  than 
tea,  on  account  of  its  being  taken  in  much  stronger 
percentage  infusion.  "  Strong  coffee,  the  cafe  noir  of 
France,  is  seen  to  have  a  very  powerful  inhibitory 
effect ; "  *  hence  it  should  not  be  taken  after  a  meal 
by  dyspeptic  persons. 

Cocoa  or  cacao. — Cocoa  is  widely  removed  by 
its  composition  and  character  from  tea  and  coffee. 
It,  however,  contains,  as  has  been  stated,  an  alkaloid 
closely  allied  tj)  caflein,  viz.  theobromin.  Cocoa  is  ob- 
tained from  the  seeds  of  an  exotic  tree,  the  Theobroma 
cacao.  The  seeds  are  extracted  from  a  pulpy  fruit 
in  which  they  are  embedded.  These,  consisting  of 
kei'nel  and  husk,  are  roasted,  after  the  manner  of 
coffee  berries,  to  dcA'elop  aroma.  Tlie  kernels  of  the 
roasted  seeds,  when  coarsely  crushed,  form  "cocoa 
nibs."  A  decoction  of  the  nibs  is  made  by  boilirtg 
gently  in  water  for  a  couple  of  houi-s,  and  then  pouring 
the  dark  brown  decoction  off'  the  undissolved  residue. 
*  "Dietetics  and  Dyspepsia-" 


Chap,  v.]  Beverages  : — Chocolate.  107 

This  is,  however,  very  vinlike  the  preparations  of  cocoa 
commonly  used ;  these  consist  usually  of  the  kernels 
ground  to  a  paste,  and  mixed  with  other  saccharine 
or  starchy  substances ;  one  of  the  objects  of  such 
admixture  being  to  lessen  the  relative  proportion  of 
fat  in  the  cocoa.  When  starchy  substances  are  used 
for  this  purpose,  the  cocoa  requii'es  boiling,  but  when 
sugar  only  is  used,  it  can  be  prepared  by  the  simple 
addition  of  boiling  water  or  milk. 

Chocolate  is  manufactured  cocoa — the  best  kinds 
from  carefully  selected  and  skilfully  prepared  seeds. 
Sugar  and  flavouring  substances  are  added  in  the 
manufacture. 

The  composition  of  cocoa,  besides  theobromin,  of 
which  it  contains  about  15  per  cent.,  includes  a  small 
quantity  of  a  volatile  oil,  to  wliich  it  owes  its  aroma, 
and  which  is  developed  in  roasting  ;  a  large  amount  of 
fat,  known  as  cacao  butter,  amounting  to  45  or  50  per 
cent. ;  about  15  to  18  per  cent,  of  albuminous  sub- 
stances ;  and  a  small  quantity  of  starch,  about  15  per 
cent.     The  ash  is  rich  in  potassium  phosphate. 

It  will  be  seen  frorn  this  analysis  that  cocoa  is  a 
highly  nutritious  food,  containing  a  considerable 
amount  of  albuminates  and  hydro-carbons,  and  a 
certain  proportion  of  carbohydrates  and  salts.  It  re- 
sembles milk  somewhat,  as  approaching  in  composition 
to  a  complete  food.  Its  defect  is  the  large  amount  of 
fat  it  contains,  which  renders  it  prone  to  disagree 
witli  persons  of  delicate  digestions.  It  is  the  avowed 
object  of  the  best  prep.\ rations  of  cocoa  to  diminish 
the  relative  amount  of  fat  by  the  addition  of  other 
suitable  substances,  or  to  promote  its  digestibility  by 
the  admixture  of  some  alkali. 

Cocoa  and  chocolate  present  a  convenient  and 
palatable  form  of  a  highly  nourishing  food,  and  in 
South  America  cocoa  and  maize  cakes  are  carried  by 
travellers  because  they  provide  an  agreeable  kind  of 
food  in  small  bulk. 

It  will  be  seen  that  it  is  only  the  decoction  of  the 
nibs  that  can  really  be  likened  to  tea  or  cofiee  as  a 


io8 


Food  in  Health. 


tPartI, 


beverage  ;  the  other  forms  of  cocoa  containing  a  large 
proportion  of  nutritious  solids. 

The  following  table,  adapted  from  Konig,  gives 
the  average  composition  of  cacao  beans  (kernels)  and 
the  best  kind  of  chocolate  : — 


Cacao  Beans. 

Chocolate. 

Water 

3-25 

1-53 

Nitrogenous  Substances 

U-76 

6  06 

Fat         

49-00 

15-25 

Starch 

13  31 

— 

Sugar     



63-81 

Other  Non-nitrogenous  lilattcra 

12-25 

11-03 

Woody  Fibre 

3-68 

1-15 

Ash        

3  65 

2-15 

Mate,  or  Paraguay  tea,  is  prepared  from  the  dried 
leaves  of  the  Ilex  paroguayensis,  belonging  to  the 
holly  tribe.  It  contains  thein,  and  its  infusion  is 
largely  consumed  in  South  America  as  a  dietetic 
beverage. 

Cliicory  is  prepared  from  the  root  of  the  wild 
endive  (Cichorium  hitybus)  by  roasting  like  cofl'ee, 
and  then  leducing  to  powder.  It  contains  an  aromatic 
volatile  oil,  which  is  considered  by  some  to  give  off  an 
aroma  like  that  of  coffee,  and  its  infusion  is  said  to  be 
drunk  pure  in  some  parts  of  the  Continent.  In  Great 
Britain  it  has  been  used  either  as  an  addition  to,  or 
an  adulteration  of,  coffee.  Added  to  coffee  in  small 
quantity  it  is  thought  by  some  to  increase  its  Havour, 
as  it  certainly  does  its  colour. 

Coca. — The  leaves  of  the  Erythi-oxylon  coca  are 
another  stimulant  possessing  somewhat  similar  proper- 
ties to  the  preceding.  Its  active  principle  is  cocaine. 
The  leaves  may  be  chewed,  or  an  extract  or  a  tincture 
made  from  them.  It  has  a  distinctly  sustaining 
effect  during  muscular  exertion,  and  in  weak  condi- 
tions acts  as  a  tonic  to  the  heart. 


Chap.  V.)  Alcoholic  Beverages,  109 

We  prefer  the  simple  spirituous  tincture  to  the 
various  coca  wines  of  commerce. 

Kola. — The  kola  nut  has  been  recommended  as  a 
nervine  stimulant,  and  as  possessing  similar  propertiep 
to  coca.     It  has  been  said  to  contain  thein. 

Alcoholic  Beverages. 

The  term  "  alcoholic  beverages  "  comprises  a  great 
variety  of  familiar  drinks,  into  the  composition  of 
which  alcohol  enters  in  widely  varying  proportions : 
the  so-called  "ardent  spirits"  and  spirituous  liquoi'S 
may  contain  as  much  as  50  per  cent.,  or  even  more, 
of  alcohol,  while  the  lighter  wines  scarcely  contain  10 
per  cent.,  and  the  weaker  kinds  of  beer  not  even  5 
per  cent.  Before  considering  the  dietetic  properties  of 
these  various  alcoholic  beverages,  it  will  be  convenient 
to  describe  briefly  what  is  known  practically  of  the 
effects  of  alcohol  on  the  human  body.  A  great  con- 
flict of  opinion  is  always  maintained  in  connection 
with  the  subject,  and  this  is,  indeed,  likely  to  be  the 
case  so  long  as  prejudice  and  dogmatic  enthusiasm  are 
allowed  to  take  so  large  a  part  in  the  discussion  of  a 
scientific  question. 

It  is  now  generally  admitted  that  only  a  portion  of 
the  alcohol  taken  into  the  body  is  eliminated  as  such ; 
a  portion,  no  doubt,  especially  when  taken  in  large 
quantity,  escapes  in  the  urine  and  breath ;  but  a 
portion,  some  maintain  a  considerable  portion,  dis- 
appears in  the  body.  What  becomes  of  this  ?  It  is 
burnt  or  transformed  within  the  body  in  the  same 
manner  as  any  other  food  of  similar  chemical  com- 
position :  this  is  the  answer  given  by  many  experi- 
menters, and  it  is  the  one  supported  by  Dujardin- 
Beaumetz*  as  the  result  of  his  own  experiments. 
"In  the  blood,"  he  says,  "you  bring  together  two 
bodies,  one  alcohol,  eager  for  oxygen,  the  other  haemo- 
globin, ready  to  give  up  that  oxygen  under  the  feeblest 
Influence ;  alcohol,  under  the  influence  of  haemoglobin, 

•  "  L'Hygifene  Alimentaire.     Des  Boissons." 


no  Food  in  Health.  iPani. 

is  tnmsforrned  into  acetic  acid.  A  portion  of  the 
alcohol  ingested  nndergoes  combustion  at  the  expense 
of  the  oxygen  of  the  haemoglolnn  of  the  blood  globules. 
When  alcohol  is  introduced  into  the  economy  in  non- 
intoxicafcing  doses,  it  is  in  part  oxidised,  and  trans- 
formed, first,  into  acetic  acid,  then  into  alkaline 
acetates,  and  finally  into  carbonates.  Alcohol,  then, 
is  a  food,  nn  aliment  cVepargne,  which  instead  of 
promoting  combustion  [of  the  tissues],  on  the  con- 
trary retards  it  by  withdrawing  a  certain  quantity  of 
oxygen  from  the  blood  corpuscles.  It  is  to  this  action 
on  the  blood  globules  that  it  owes  its  power  of  lower- 
ing the  temperature  of  the  body,  especially  notable 
when  toxic  doses  are  administered.  In  such  instances 
the  alcohol  is  no  longer  consumed,  but  it  destroys  the 
blood  corpuscles  and  dissolves  the  oxyhsemoglobin. 
That  portion,  however,  of  the  ingested  alcohol  which 
does  not  undergo  combustion,  acts  directly  on  the 
cerebro-spinal  nervous  system,  giving  rise  to  the  phe- 
nomena of  intoxication,  of  sleep,  and  of  vaso-motor 
changes  varying  according  to  the  amount  of  alcohol 
ingested.  These  three  properties  of  alcohol,  alimentary, 
anti-thermic,  and  toxic,  render  alcoholic  beverages 
most  powerful  remedies  in  febrile  diseases."  This 
opinion  has  the  merit  of  chiarness  and  definiteness, 
and  is  founded  on  the  results  of  careful  experiment. 

Bauer*  is  disposed  to  explain  its  favourable  effects 
solely  on  the  ground  of  its  exciting  and  stimulating 
properties,  and  he  considers  its  nutritive  properties  to 
be  insignificant. 

Pavyt  considers  the  weight  of  evidence  to  be  in 
favour  of  its  being  regarded  as  a  food,  and  that 
when  taken  in  moderate  quantities  the  greater  part 
is  utilised  in  the  system,  and  only  a  small  portion  is 
eliminated. 

"What  it  is  important  to  note,  with  regard  to  its 
stimulating  effects,  is  that  they  are  temporary,  and 
quickly  give  place  to  a  sedative,  and  in  some  persons, 

*  '« Dietary  of  the  Sick." 

A  Treatise  on  Food  and  Dietetics." 


Chap. v.]  Alcoholic  Beverages,  hi 

even  in  moderate  quantities,  to  a  depressing  effect. 
It  produces,  then,  temporary  stimulating  eHects  on 
the  nervous  and  circulatory  systems ;  there  is,  for  a 
time,  mental  exhilaration  and  a  more  rapid  flow  of 
ideas,  while  there  is  also  quickened  action  of  the  heart 
and  increased  fulness  of  the  pulse.  This  is  followed 
by  a  sedative  effect  on  the  nervous  system,  often  of 
very  great  value.  It  has  also  the  effect  of  causing 
dilatation  of  the  peripheral  blood-vessels,  in  conse- 
quence of  which  the  face  flushes,  and  there  is  a  sub- 
jective feeling  of  warmth  following  its  use. 

In  small  quantities,  by  stimulating  the  secretion 
of  the  gastric  juice,  it  promotes  appetite,  but  in  large 
quantities  it  has  the  opposite  effect,  and  is,  as  will 
presently  be  seen,  a  retarder  of  digestion. 

In  its  action  on  the  nervous  system  small  quantities 
exliilarato,  large  quantities  (after  a  brief  period  of 
excitement)  are  sedative  and  narcotic. 

It  is  most  important  to  remember  that  tJie  effects 
of  alcohol  vary  very  greatly  in  diff'erent  individuals, 
and  that  what  may  only  be  suflicient  to  produce  a 
pleasant  exliilaration  in  one  person,  will  cause  toxic 
depressing  effects  in  another. 

Indeed,  it  is  mainly  on  account  of  the  remarkable 
difference  in  its  effects  on  dilierent  persons  that  «io 
much  misapprehension  exists  as  to  its  true  character. 

Alcohol  is  a  useful  food  and  an  agreeable  stimu- 
lant, or  a  narcotic  poison,  according  to  the  dose  in 
which  it  is  taken,  or  the  susceptibilities  and  tissue 
reactions  of  the  individuals  to  whom  it  may  be  ad- 
ministered. 

Experiments  as  to  the  effect  of  alcohol  in  health 
have  generally  been  made  with  too  large  doses,  so  that 
they  have  only  furnished  information,  valuable  cer- 
tainly so  far  as  it  goes,  of  the  effects  of  alcohol  in 
excess.  For  instance,  to  test  the  effect  of  alcohol  on 
muscular  exertion  by  giving  a  man  four  ounces  of 
brandy  every  four  hours  (!)*  was  useless  for  the 
purpose  of  elucidating   the  physiological   effects   of 

•  Experiment  quoted  in  Parkes's  "  Hygiene." 


112'  Food  IN  Health.  [Parti. 

moderate  doses  of  alcohol.  This  was  a  poisonous  dose, 
and  antecedently  to  its  administration  it  might  natur- 
ally have  been  expected  to  produce  toxic  effects,  and 
therefore  to  embarrass  rather  than  promote  muscular 
exertion. 

Experience  has  taught  us  that  for  temperate, 
healthy  persons,  unaccustomed  to  the  free  use  of 
alcohol,  one  ounce  of  brandy  or  whisky,  freely  diluted, 
is  as  much  as  should  be  taken  at  a  time,  if  it  is  desired 
to  avoid  any  of  its  depressing  and  toxic  effects ;  and 
experiments  undertaken  with  the  object  of  testing  the 
physiological  action  of  alcohol  in  moderation  should  be 
restricted  to  doses  of  this  amount.  It  is,  indeed,  pointed 
out,  in  the  last  edition  of  Parkes's  "  Hygiene  "  that 
"  one  to  one  and  a  half  fluid  ounce  of  absolute  alcohol 
in  twenty- four  hours  is  the  maximum  amount  which  a 
healthy  man  should  take ; "  whether  in  the  form  of 
ardent  spirits,  wine,  or  beer,  and  with  this  opinion  we 
are  entirely  in  accord. 

That  alcohol  taken  in  small  quantities  improves 
the  appetite  and  beneficially  increases  the  circulatory 
activity,  is  almost  universally  admitted.  Of  its  value 
as  a  sedative  to  the  nervous  system  in  certain  diseased 
conditions,  there  is  also  nearly  a  general  acknowledg- 
ment; as  to  its  influence  on  the  work  of  the  body, 
physical  and  mental,  it  would  seem,  when  taken  in 
the  moderate  quantity  above  stated,  to  be  helpful  under 
many  circumstances.  Taken  in  larger  quantity  it 
would  seem,  on  the  contrary,  to  be  almost  invariably 
hurtful ;  women  appear  to  be  more  susceptible  to  its 
injurious  effects  than  men,  and  should  take  it  with 
even  greater  moderation,  and  healthy  children  should 
do  witliout  it  altogether. 

Alcohol  taken  in  excess  is  known  to  lead  to  very 
serious  morbid  changes  in  nearly  all  the  organs  of  the 
body.  Chronic  inflammatory  and  degenerative  changes, 
of  a  granular  fibroid  and  fatty  nature,  attack  the 
stomach,  liver,  lungs,  kidneys,  the  brain  and  its 
membranes,  and  especially  the  blood-vessels.  This, 
however,  is  not  the  place  to  discuss  the  many  and 


Chap,  v.]  Alcoholic  Beverages.  113 

serious  morbid  conditions  which  are  produced  by  the 
excessive  use  of  alcohol. 

With  regard  to  the  influence  of  alcohoHc  beverages 
on  the  digestive  processes,  Sir  William  E-oberts  has 
made  some  valuable  experiments,  and  the  conclusions 
he  has  arrived  at  with  regard  to  spirits  may  be  thus 
briefly  summarised  : — 

With  respect  to  ai'dent  spirits,  such  as  brandy, 
Scotch  whisky,  and  gin,  he  found  that  these  spirits, 
used  in  moderation,  and  well  diluted,  promote  rather 
than  retard  salivary  digestion ;  that  they  increase  the 
salivary  secretions. 

*'  The  common  practice  of  adding  a  tablespoonful 
of  brandy  to  a  basin  of  arrowroot  or  sago  gruel  there- 
fore promotes  its  digestion." 

With  regard  to  peptic  digestion,  it  was  found  that 
with  10  per  cent,  and  under  of  proof  spirit,  there  was 
no  appreciable  retardation,  and  only  a  slight  retarda- 
tion with  20  per  cent.,  but  with  large  percentages  it 
was  very  diflerent,  and  with  50  per  cent,  the  digestive 
ferment  was  almost  paralysed. 

In  the  proportions  in  which  these  spirits  are 
usually  employed  dietetically,  not  only  do  they  not 
appreciably  retard  digestion,  but  they  "'  act  as  pure 
stimulants  to  gastric  digestion,  causing  an  increased 
flow  of  gastric  juice  and  stimulating  the  muscular  con- 
tractions of  the  stomach,  and  so  accelerating  the  speed 
of  the  digestive  process  in  the  stomach." 

It  will  be  necessary,  in  the  next  place,  to  consider 
the  properties  of  the  various  beverages  containing 
alcohol  which  are  in  common  use. 

Spirits.— The  various  "  ardent  spirits "  are  ob- 
tained by  distillation  from  fermented  liquids,  and  their 
odour  and  flavour  depend  on  the  nature  and  source  of 
the  fluid  from  which  they  are  distilled  They  are 
usually  met  with  in  commerce  of  about  the  strength 
oi  proof  spirit,  i.e.  49  parts  of  alcohol  to  51  of  water, 
and  having  a  specific  gravity  of  0920  at  60®  Fahr. 
When  they  contain  a  larger  proportion  of  alcohol  their 
I 


114  Food  in  Health.  [Parti. 

specific  gravity  is  lowered,  and  they  arc  then  said  to 
be  so  many  degrees  over-proof ;  whereas,  if  they  contain 
a  smaller  quantity  of  alcohol  their  specific  gravity  is 
raised,  and  they  are  said  to  be  so  many  degrees  under- 
proof. 

Practically,  these  distilled  spirits,  when  pure,  may 
be  looked  upon  merely  as  mixtures  of  alcohol  and 
water ;  the  differences  in  their  flavours  and  odours 
depend  on  the  presence  of  various  ethers,  or  of  volatile 
oils,  derived  from  the  various  fermented  fluids  from 
whicli  they  are  distilled,  or  purposely  added.  Some 
are  sweetened  by  added  sugar,  and  some  are  intention- 
ally coloured  by  the  addition  of  colouring  substances. 

Brandy,  rum,  whisky,  and  gin  are  the  spirits  most 
in  vogue  in  Great  Britain. 

Brandy,  cog^nac,  or  can  de  vie,  when  of  the 
best  quality,  is  distilled  from  wine  or  fermented  grapes. 
There  is,  however,  a  great  quantity  of  eau  de  vie 
fabricated  in  France,  of  an  inferior  quality,  from 
potato-spirit  or  grain  spirit,  i.e.  spirit  distilled  chiefly 
from  rice,  maize,  etc. 

The  quality  of  brandy  depends  on  the  kind  of  wine 
from  which  it  is  distilled  ;  the  finest  quality  comes 
from  the  white  wines  of  the  Charentes.  The  colour 
of  brandy  is  due  to  its  being  kept  in  an  oak  cask, 
from  which  also  it  extracts  some  tannin.  Caramel  is 
used  to  colour  the  inferior  kinds.  Its  aroma  and 
flavour  are  due  to  the  presence  of  volatile  ethers, 
which  pass  over  during  distillation.  Brandy  im- 
proves in  flavour  by  keeping,  while  it  loses  in  strength. 
On  an  average  it  contains  about  42  per  cent,  of 
alcohol.  Dietetically  it  is  highly  valued,  when  of 
good  quality,  for  its  delicacy  of  flavour  and  its  purity 
as  a  spirit. 

Rum  is  distilled,  in  the  West  Indies  especially, 
from  the  fermented  products  of  the  sugarcane.  When 
new  it  is  of  somewhat  coarse  flavour,  which  becomes 
greatly  refined  by  age.  It  is  the  spirit  usually  served 
out  in  the  British  army  and  navy.  It  is  of  about  the 
same  strength  as  brandy. 


Chap,  v.]  Alcoholic  Beverages.  115 

"Whisky  is  extensively  distilled  in  Scotland  and 
Ireland  from  malted  grain,  usually  barley.  The 
smoky  flavour  is  due  to  the  peat  and  ^wr/"  fires  used  in 
drying  tlie  grain.  A  certain  amount  of  age  is  necessary 
to  render  whisky  wholesome.  It  may  be  used  in  the 
same  manner  as  brandy,  and  is  more  likely  to  be 
obtained  pure  than  that  spirit, 

Oin  and  Hollands  are  corn  spirits,  distilled  from 
the  unmalted  grain.  It  is  necessary  in  this  case  that 
the  first  distillation  should  be  purified  by  re- distilla- 
tion. Gin  is  flavoured  subsequently  by  the  addition 
of  juniper  and  other  flavouring  agents ;  it  is  also 
sweetened  by  the  addition  of  sugar,  so  that  gin  may 
be  obtained  either  "  diy  "  or  "  sweet."  Dry  Plymouth 
gin  is  one  of  the  most  wliolesome  kinds.  It  is  more 
diuretic  than  other  spiriLs,  on  account  of  the  juniper 
it  contains. 

Arrack  is  a  spirit  distilled  from  a  fermented 
infusion  of  rice. 

Kirsch,  or  Kirscli-wasser,  is  a  spirit  largely 
drunk  in  Germany  and  on  the  Continent.  It  is  dis- 
tilled from  cherries. 

Spirits  distilled  from  grain  or  from  the  potato 
are  apt  to  be  contaminated  with  ami/lie  and  other 
alcohols  of  injurious  quality.  As  arnylic  alcohol,  or 
fusel-oil,  is  less  volatile  than  ordinary  or  ethylic 
alcohol,  by  redistillation  the  latter  can  be  separated 
from  the  former,  which  is  left  behind  in  the  still. 

Dujardin-Beaumetz  has  shown  that  the  toxic 
character  of  alcohols  increases  with  their  atomic 
weights,  and  each  of  the  alcohols  in  the  following 
series  presents  more  and  more  poisonous  properties 
as  its  atomic  weight  increases : — 

Ethylic  Alcohol CHgO 

Propvlic      , C'jHgO 

Butylic        „      CJijoO 

Amylio        „       CjHi^O 

The  higher  the  alcohol  in  the  series  the  more  toxic  it 
becomes. 
I  2 


ii6  Food  in  Health.  [PartL 

Brandy  distilled  from  wine  contains  only  very 
small  quantities  of  these  toxic  alcohols,  but  eau  de  vie 
distilled  from  potatoes  or  from  grain  contains  a  much 
larger  quantity  of  propylic,  butylic,  and  amylic  alcohol. 

As  to  the  influence  on  the  digestive  processes 
of  the  various  spirits  in  common  use,  Sir  W.  Roberts 
found  yin  preferable  to  either  brandy  or  whisky  j  in 
his  experiments  he  noticed  that  brandy  and  Scotch 
whisky  interfered  with  the  digestive  processes,  "  pre- 
cipitated the  starch  more  readily,"  altogether  out  of 
proportion  to  the  amount  of  alcohol  they  contained, 
and  brandy  was  worse  than  whisky  ;  and  this  circum- 
stance appears  to  be  due  to  certain  ethers  and  volatile 
oils  in  them  ;  and  brandy  contains  a  trace  of  tannin, 
which  has  an  intensely  retarding  influence  on  salivary 
digestion. 

Little  need  be  said  of  the  various  alcoholic 
liqueurs  in  ordinary  use.  They  owe  their  sweetness 
to  added  sugar,  and  their  characteristic  flavours  to 
various  aromatic  substances.  Curagoa  is  flavoured 
with  orange  peel;  Noyeau  with  the  kernels  of  the 
])each  and  apricot ;  Maraschino  with  a  flavour  derived 
from  cherries ;  Kiimmel  with  cumin  and  carraway 
seeds ;  Anisette  with  aniseed  and  coriander. 

Ciuirtreuse  and  Benedictine,  etc.,  are  distilled  from 
a  mixture  of  various  aromatic  substances. 

Absinthe  is  bitter,  being  flavoured  with  wormwood. 
It  is  usually  taken  mixed  with  water,  before  a  meal, 
to  stimulate  appetite. 

Wines.— We  have  seen  that  alcohol  and  the 
ardent  spirits  are  obtained  by  distillation  from  saccha- 
rine fluids  that  have  undergone  fermentation.  The 
juices  of  all  saccharine  fluids  can  be  made  to  undergo 
the  alcoholic  fermentation.  This  is  usually  set  up  by 
the  agency  of  the  yeast  fungus,  which  causes  the 
sugar  to  break  up  into  ethylic  alcohol  and  carbonic 
acid. 

The  most  ancient  and  mpst  popular  of  these  fer 
mentcd  drinks  are  those  which  have  been  obtained. 


Chap,  v.]  Beverages  : —  Wines.  i  17 

since  the  earliest  times,  from  the  juice  of  the  grape ; 
and  it  is  to  the  fermented  juice  of  the  grape  that  the 
term  "  wine  "  usually  applies.  This  term  is,  however, 
also  applied  to  the  fermented  juice  of  othei'  saccharine 
fruits,  as  that  of  the  orange,  elder,  gooseberry, 
currant,  etc. 

The  characters  and  properties  of  wines  are  deter- 
mined not  only  by  the  variety  of  the  vine  on  which 
the  grapes  are  grown,  but  also  by  circumstances  of 
soil,  of  climate,  of  season  as  iniluenced  by  weather,  of 
degrees  of  ripeness  when  the  grapes  are  gathered,  and 
of  modes  of  manufacture  and  preparation. 

"In  the  manufacture  of  white  wines,  the  grape 
juice,  after  having  been  left  for  several  days  in  contact 
with  the  crushed  skins,  in  order  that  the  soluble  con- 
stituents of  these  may  be  extracted,  is  pressed  out,  and 
the  iniist  (the  name  given  to  the  expressed  juice)  so 
obtained  is  submitted  to  fermentation,  which  sets  up 
of  itself  on  mere  exposure  to  air,  by  means  of  the  yeast 
germs  everywhere  present.  To  make  a  red  wine,  the 
juice  of  black  grapes  is  fennented  together  with  the 
skins  and  stones  (and  sometimes  the  stalks),  and  the 
colouring  matters  as  well  as  the  tannin  contained  in 
these  are  dissolved  out  into  the  wine."* 

Konig  gives  the  following  as  the  average  per- 
centage composition  of  grape  must : — 

Water        74-49 

Nitrogenous  Substances 0-28 

Sugar          19-71 

Acid            0-64 

Other  Non-nitrogenous  Substances       ...  4-48 

Ash 0-40 

Great  fluctuations  are  observed  in  the  proportions 
of  sugar  and  acid  as  determined  by  the  circumstances 
mentioned  above.  Even  in  the  same  localities, 
difference  of  season  will  cause  the  sugar  to  vary 
from  12  to  24  per  cent.;  and  the  acid  from  05 
to  1  -2  per  cent. 

*  Bauer. 


ii8  Food  in  Health.  [PartL 

The  ash  consists  chiefly  of  potash  and  phosphoric 
acid.  The  must,  of  course,  undergoes  great  changes 
in  composition  during  the  processes  of  fermentation 
and  preparation.  The  sugar  is,  in  great  part,  con- 
verted into  alcohol,  glycerin  and  succinic  acid  being  at 
the  same  time  formed.  The  fermentation,  however, 
in  many  wines  is  arrested  before  the  whole  of  the 
sugar  has  been  exhausted,  and  the  proportion  of 
sugar  thus  left  in  the  wine  gives  it  one  of  its 
distinctive  characters. 

The  tannin,  which  gives  astringency  to  wine,  is 
only  found  in  any  considerable  amount  in  red  wines, 
and  is  derived  from  the  stones,  the  skins,  and  the 
stalks.  The  aroma  of  wines  is  usually  developed 
during  fermentation  and  after  it  has  been  in  bottle ; 
but  in  some  instances,  as  in  the  Muscat,  it  depends  on 
the  grape  itself. 

The  chief  acids  of  must  are  malic  and  tartaria 
Malic  acid  is  found  principally  in  the  unripe  grape. 
They  both  diminish  in  amount  as  the  fruit  ripens, 
while  the  proportion  of  sugar  at  the  same  time 
increases. 

Good  wine  should  not  contain  more  than  0*5  per 
cent,  of  tartaric  acid.  Owing  to  the  variability  of 
climate  and  seasons  in  the  north  of  Europe,  and 
the  consequent  imperfect  ripening  of  the  grape  in 
certain  years,  the  Rhenish  and  Moselle  wines  are  apt 
at  times  to  contain  an  excess  of  acid. 

The  amount  of  sugar  in  wine  depends  much  on 
climate,  the  grapes  grown  in  hot  climates  contain- 
ing much  more  saccharine  matter  than  those  grown 
in  colder  regions.  It  also  depends  on  the  degree 
of  ripeness  of  the  fruit  when  gathered,  and  so  also 
upon  the  season,  for  in  cold,  wet  seasons  the  grapes 
will  not  ripen  tlioroughly,  and  will  therefore  con- 
tain less  sugar.  The  amount  of  sugar  will  vary  in 
different  wines  from  10  to  30  per  cent.  In  order 
to  make  good  wine  the  must  should  contain  not 
less  than  20  per  cent,  of  sugar.  Warm  and  dry 
summers  are  advantageous,  and  influence  favourably 


Chap,  v.]  Beverages  : — Wines.  119 

the  wine  produced.  In  the  preparation  of  some  of 
the  richest  and  choicest  wines,  such  as  Chateau 
d'Yquem  and  Tokay,  only  fully  ripe,  or  even  over- 
ripe, grapes,  rich  in  saccharine  substances,  are 
selected. 

The  colour  and  astringency  are  extracted  from  the 
skins  and  stalks  during  fermentation,  to  a  great 
extent  by  the  combined  action  of  the  alcohol  generated 
during  this  process  and  the  acids  ;  at  the  same  time 
the  exhausted  organic  ferment,  with  other  organic  sul> 
stances  and  "  cream  of  tartar,"  are  deposited  as  lees. 

Certain  wines  are  "  fortified  "  by  the  addition  of 
spirit,  especially  the  wines  grown  in  hot  countries,  as 
in  Spain,  Portugal,  Madeira,  etc.  The  spirit  is  added 
for  the  purpose  of  checking  fermentation  before  all 
the  saccharine  matter  is  exhausted.  Such  wines 
possess  much  "body"  and  "  fruitiness, "  on  account 
of  the  amount  of  saccharine  and  extractive  matters 
retained  in  them.  In  cooler  climates,  as  in  France 
and  Germany,  the  fermentation,  which  proceeds  more 
slowly,  is  allowed  to  terminate  spontaneously,  and 
the  saccharine  matter  is  almost  wholly  exhausted. 
Such  wines  are  "  drier,"  mature  more  rapidly,  and 
acquire  a  finer  aroma  or  bouquet.  This  bouquet  or 
aroma  depends  upon  the  ethereal  products  formed  by 
a  combination  of  fi*ee  acid  with  alcohol,  and  therefore 
appears  more  constantly  in  the  acid  wines  of  the 
north. 

The  cream  of  tartar  thrown  down  in  the  lees  is 
deposited  in  proportion  as  the  alcohol  is  formed,  as  it 
is  very  sparingly  soluble  in  spirit.  A  further  deposit 
of  this  insoluble  salt  takes  place  after  the  wine  has 
been  drawn  off  into  casks  ;  it  then  assumes  a  crystal- 
line form,  and  is  known  as  "argol."  The  /ininy  of 
wine  consists  in  adding  to  it  white  of  egg,  isinglass,  or 
some  similar  substances,  which,  being  coagulated  and 
precipitated  by  the  action  of  the  wine,  entangles  and 
carries  down  with  it  the  suspended  organic  and  other 
impurities.  The  wine  is  thus  rendered  clear,  bright, 
and  durable. 


I20  Food  in  Health.  [rani. 

Plastering  is  the  term  applied  to  the  practice  that 
prevails  in  Spain,  Portugal,  and  the  south  of  France, 
of  either  dusting  plaster  of  Paris  (sulphate  of  lime) 
over  the  grapes  before  they  are  crushed,  or  adding  it 
to  the  must.  This  leads  to  the  deposition  of  the 
greater  part  of  the  natural  tartaric  acid  in  combination 
with  lime,  and  to  the  substitution  of  sulphate  of  potash 
in  its  place,  an  altogetlier  undesirable  change  so  far  as 
wholesomeness  is  concerned,  but  the  keeping  proper- 
ties of  the  wine  are  probably  improved. 

In  the  preparation  of  sparkling  wines  like  cham- 
pagne, a  second  fermentation  is  set  up  by  the  addition 
of  syrup,  and  some  of  the  carbonic  acid  is  prevented 
from  escaping,  so  that  an  effervescing  character  is 
given  to  the  wine,  while  a  special  flaAOur  is  imparted 
by  the  addition  of  "liqueur." 

Little  that  is  of  practical  value  can  be  learnt  from 
the  minute  chemical  analysis  of  a  wine  ;  the  palate 
and  the  stomach  are  the  most  reliable  tests  of  its  quality 
aud  wholesomeness. 

Dujardin-Beaumetz  well  remarks  tliat  "  it  is  a  pro- 
found error  to  regard  wine  as  merely  a  mixture  of 
water  and  alcohol.  It  is  a  complete,  living  whole  .  . 
a  living  being  "  of  very  complex  constitution.  "  It 
has,"  he  goes  on  to  say,  "  its  youth,  its  maturity,  and 
its  old  age.  Some  growths,  like  those  of  Burgundy, 
have  a  short  life  and  a  precocious  old  age  ;  others, 
like  Bordeaux,  have  a  much  longer  life,  and  are  even 
made  to  travel  to  hasten  their  maturity.  They  have 
also  their  diseases,  diseases  which  result  most  com- 
monly from  bad  manufacture  or  fault}'  fei-mentation 
giving  rise  to  the  presence  of  impure  products."  Be- 
sides water  and  alcohol,  wines  contain  glycerin,  sugar, 
tannin,  essential  oils,  ethers,  colouring  matters  and 
extractives,  acids,  and  salts ;  and  a  wine  will  contain 
these  constituents  in  different  proportions  in  different 
periods  of  its  existence. 

The  proportion  of  alcohol  in  wine  varies  from  6 
to  25  per  cent.  ;  and  it  is  stated  that  a  natural  wine 
derived  from  the  normal  fermentation  of  the  grape 


Chap,  v.] 


Beverages  :  —  IVine^. 


cannot  yield  more  than  17  per  cent,  and  that  any 
amount  beyond  thi$  must  be  added.  It  is  also  said 
that  a  pipe  of  11 5  gallons  of  port  wine  has  never  less 
than  3  gallons  of  brandy  added  to  it,  and  some  of  the 
richer  wines  have  as  much  as  13  to  15  gallons  added ; 
and  that  to  108  gallons  of  sherry,  there  are  added 
6  to  8  gallons  of  brandy.  Some  of  the  finest 
wines  do  not  contain  more  than  6  to  10  per  cent. 
of  alcohol. 

The  following  table  of  the  average  percentage 
by  volume  of  alcohol  in  some  of  the  best-known  wines 
is  collated  from  the  tables  published  by  Bauer, 
Dujardin-Beamuetz,  and  Parses  : — 


Per  cent,  of  Alcohol 

Sherry          

..     22-90 

Port 

..     21-91 

Marsala 

..     20-44 

Madeii-d        

..      1911 

Tokay           

..     12-74 

Grave           ..          

.      12-30 

Champagne  (Sparkling)     

..     11-70 

Rudesheirner 

..     11-60 

Zeltjngcr 

..     11-20 

Ruster          

..     11-08 

vXTy  1  ^"^•S""'!^*^''         

..     1100 

Johannisbcrg 

..     1000 

Voslauer       

..       9-89 

Larose           

..       9-85 

St.  Juli^n 

...       9-2S 

Leoville        

..       910 

Chateau  Margaux    ,,. 

..       8-75 

„       Lafitte        ...         

..       8-73 

Chablis         

...       7-88 

It  is  only  in  the  sweet  liqueur-like  wines  and  in 
those  to  which  sugar  is  added  in  the  manufacture, 
that  this  substance  exists  in  any  considerable  amount. 
According  to  Bauer,  Buster  contains  21 '74  per  cent, 
of  sugar,  Tokay  14  99,  Malaga  16-57,  CJiampague 
11-53,  Sparkling  Hock/8-i9,  Port  6"42,  Marsala  3.48, 
Madeira  3-46,  Slierry  1*88. 

In  the  Rhenish  and  Moselle  wines  there  is  but  a 


122  Food  in  Health.  [Parti. 

very  small  quantity  of  sugar.  In  Johannisberg  only 
0'42  per  cent.,  in  Rudesheimer  0'39,  in  Zeltinger  0*13, 
and  in  Stein- Reisling  0-01. 

In  Clarets  and  Burgundies  it  is  either  absent,  or 
present  in  very  small  quantity. 

The  amount  of  tannin  found  in  different  wines 
varies  greatly.  As  it  is  derived  chiefly  from  the 
coloured  skin  of  the  grape,  it  is  absent,  or  in  very 
small  quantity,  in  white  wines.  New  ports  contain  it 
in  greatest  quantity.  On  keeping,  the  tannin  becomes 
deposited  in  combination  with  cream  of  tartar  and 
colouring  and  extractive  matters,  and  forms  what  is 
known  as  the  "  crust." 

Most  wines  contain  some  free  acid,  as  well  as  the 
acid  bitartrate  of  potash.  The  free  acid  is  cbiefly 
tartaric,  with  smaller  quantities  of  malic  and  acetic 
acids.  The  white  wines  contain  most  free  acid, 
the  Rhenish  and  Moselle  wines  from  1*14  per  cent. 
(Marschberg)  to  033  (Rudesheimer),  Champagne 
0*58,  port  and  sherry  about  0*45,  clarets  about 
0-60. 

The  bouquet  and  aroma  of  wines  depend  chiefly  on 
the  presence  of  compound  ethers  and  volatile  oils.  The 
ethers,  the  chief  of  which  is  termed  oinant/iic  ether, 
are  developed  in  the  wine  as  it  ages,  and  become 
especially  noticeable  after  it  has  been  long  in  bottle. 
They  are  formed  by  the  reaction  of  the  acids  in  the 
wine  on  the  alcohol,  and  are  therefore  more  remark- 
able in  the  more  acid  wines  as  in  those  of  the  Rhine 
and  Moselle. 

These,  then — the  alcohol,  the  sugar,  the  tannin,  the 
free  acid,  and  the  ethers — are  the  chief  constituents  of 
wine  from  a  dietetic  point  of  view. 

Some  authors  divide  wines  into  four  classes  : — (1) 
Spirituous  or  liqueur  wines ;  (2)  red  or  astringent 
wines ;  (3)  white  or  acid  wines ;  and  (4)  sparkling 
wines.* 

The  liqueur,  or  spirituous  wines,  such  as  Sherry, 
Port,  Madeira,  Marsala,  Malaga,  etc.,  are  wines  which 
*  Dujardin-Beaumetz  :  "Pes  BoissoDS,"  op.  cit. 


Chap,  v.]  Beverages: — Waves.  123 

contain  more  than  1 5  per  cent,  of  alcohol.  They  are 
called  dry  when  nearly  all  the  sugar  of  the  grape  is 
converted  into  alcohol,  as  in  dry  sherries ;  and  sac- 
charine when  the  fermentation  is  arrested  before  all 
the  sugar  has  been  exhausted,  as  in  Malaga,  fruity 
Ports,  etc.  Some  of  these  are  termed  in  French, 
vin  cuits,  or  "  cooked  wines,"  because  the  fermenta- 
tion is  arrested,  and  the  saccharine  matters  retained 
by  heating  them  to  a  certain  temperature.  Most  of 
them  contain  added  alcohol. 

The  red  wines  are  most  of  them  slightly  astringent 
and  tonic  from  the  tannin  they  contain.  The  most 
esteemed  and  useful  are  the  French  wines — the  clarets 
or  Bordeaux  wines  and  the  Burgundies. 

The  cheaper  kinds  are,  however,  so  largely 
adulterated  in  France  that,  as  they  are  imported  into 
Great  Britain,  they  are  often  mixtures  of  various 
worthless  wines  artificially  coloured. 

Sound,  well-made  clarets  and  Burgundies  are 
amongst  the  most  wholesome  of  wines,  taken  in 
moderation  and  somewhat  diluted  with  water,  as  is 
usual  in  France. 

The  Burgundies  contain  more  alcohol  than  the 
Bordeaux  wines,  and  are  considered  more  "heady," 
but  they  are  valuable  when  a  somewhat  stronger  and 
more  tonic  wine  is  needed. 

The  red  Hungarian  wines,  such  as  Carlowitz  and 
Ofner,  form  good  substitutes  for  French  wines. 

The  white  or  acid  wines  contain  less  tannin  and 
more  free  acid  than  the  preceding.  They  are  some- 
times more  diuretic,  and  are  wholesome  and  refresh- 
ing, especially  when  diluted  with  some  alkaUne  table 
water,  which  removes  the  excess  of  acidity  without 
injury  to  the  other  qualities  of  the  wine.  Most  of 
these  wines  are  grown  in  northern  countries,  and 
come  from  the  banks  of  the  Rhine  and  Moselle. 
France  also  has  several  white  wines,  such  as  Barsac, 
Vin  de  Grave,  and  the  Sauternes,  from  the  Bordeaux 
district ;  and  Chablis,  from  Burgundy.  Many  of  the 
Sauternes,  however,  are  strong  saccharine  wines,  and 


124  Food  IN  Health.  [Pani. 

cannot  be  said  to  resemble  greatly  the  white  acid 
wines  of  the  north.  Some,  also,  of  the  white 
Hungarian  wines,  as  Ruster,  are  rich  in  saccharine 
constituents. 

The  type  of  sparkling  wines  is  champagne.  This 
wine,  when  pure  and  sound,  is  most  valuable  as 
a  a-apidly-acting  restorative  and  stimulant,  and  is 
often  of  great  service  from  its  power  of  allaying 
irritability  of  the  stomach  by  means  of  the  carbonic 
acid  it  contains. 

"With  regard  to  the  influence  of  wines  on  the 
digestive  processes,  Sir  W.  Roberts  has  made  some 
instructive  observations.  He  found  that  even  very 
small  quantities  of  the  stronger  and  lighter  wines — 
sherry,  hock,  claret,  and  port — exercised  a  powerful 
retarding  influence  on  salivary  digestion.  He  con- 
siders this  to  be  wholly  due  to  the  acid — not  the 
alcohol — they  contain  ;  for  if  this  acid  be  neutralised, 
by  mixing  with  the  wine  some  alkaline  water,  the 
disturbing  effect  on  salivary  digestion  is  completely 
removed.  "The  use  of  'alkaline  table  waters  '  as  an 
addition  to  wines  is/'  Sir  W.  Roberts  observes,* 
"highly  commendable,"  as  they  "greatly  mitigate  or 
wholly  obviate  the  retarding  influence  of  these  wines 
on  the  digestion  of  starch." 

It  was  also  found  that  they  likewise  retarded  peptic 
digestion  to  an  extent  altogether  out  of  proportion  to 
the  quantity  of  alcohol  they  contained.  Port  and 
sherry  exercised  a  great  retarding  effect.  "  Even  in 
the  proportion  of  20  per  cent.,  sherry  trebled  the 
time  in  which  digestion  was  completed."  This,  then, 
is  a  most  unsuitable  wine  for  persons  of  feeble 
digestive  powers. 

With  hock,  claret,  and  champagne,  it  was  also 
ascertained  that  tins  retarding  effect  on  digestion  was 
out  of  proportion  to  the  alcohol  contained  in  them  ; 
but  champagne  was  found  to  have  '''  a  markedly  less 
retarding  effect  than  hock  and  claiet ; "  indeed,  in  the 
proportion  of  10  per  cent.,  champagne  had  a  distinct, 
*  "  Dietetics  and  Dyspepsia." 


Chap,  v.]     Beverages: — Cider  and  Perry.       125 

though  slight,  accelerating  effect,  and  this  superiority 
of  champagne  appears  to  be  due  to  the  "  mechanical 
effects  of  its  eftervescing  qualities."  Tlie  final  con- 
clusion arrived  at  by  Sir  W.  Roberts  is  that,  while 
large  quantities  of  these  wines  exercise  a  considerable 
retarding  effect  on  peptic  digestion,  small  quantities 
do  not  produce  any  appreciable  retarding  effect,  but 
act  as  pure  stimulants ;  that  sparkling  wines  impede 
digestion  less  tlian  the  still  ones,  and,  when  taken  in 
moderate  quantity,  "act  not  only  as  stimulants  to  the 
secretion  of  gastric  juice  and  to  the  muscular  activity 
of  the  viscus,  but  may,  at  the  same  time,  slightly 
accelerate  the  speed  of  tlie  chemical  process  in  the 
stomach." 

In  the  dietetic  use  of  wines,  as  the  author  has 
elsewhere  observed,*  those  wines  agree  best  and  are 
most  useful  which  are  absorbed  and  eliminated  from 
the  system  with  the  yreatest  rapidity,  as  tested  by  the 
increase  of  the  renal  secretion,  and  he  has  been  led  to 
the  practical  conclusion  that  this  is  the  best  criterion 
of  the  suitability  of  any  particular  wine  to  any  parti- 
cular constitution.  If  the  effect  of  different  wines  on 
notoriously  gouty  persons  be  carefully  observed,  it  will 
be  found  that  some  can  drink  champagne  (in  modera- 
tion, of  course)  with  impunity,  especially  if  a  small 
quantity  of  an  effervescing  alkaline  water  be  added 
to  it,  while  claret  will  at  once  provoke  some  mani- 
festations of  gout ;  othei-s  who  are  unable  to  drink 
champagne  without  provoking  a  gouty  paroxysm, 
will  often  be  able  to  drink  a  mature,  fine,  soft  claret 
with  advantage ;  others  will  support  hock  well,  and  a 
few  can  drink  fine  sherries  and  j)orts  in  small  quanti- 
ties ;  but  in  all  it  will  be  found  that  the  test  of  the 
suitability  of  the  particular  wine  to  the  particular 
constitution  is  its  susceptibility  to  rapid  elimination, 
and  vice  versd. 

Cider  and  perry. — These  fermented  beverages, 
obtained  respectively  fi'om  the  saccharine  juices  of 

*  "Food  Accessories:  their  Influence  on  Digestion." — Nine- 
teenth  Century,  February,  1S8G. 


126  Food  in  Health.  [PartL 

the  apple  and  the  pear,  have  much  in  common  with 
"wines ;"  and,  indeed,  in  Germany  cider  is  known  as 
"  api)le-Aviiie."  They  are  usually  made  in  districts 
where  those  fruits  abound. 

Their  "alcoholic"  strength  varies.  In  England 
and  in  Germany  it  lias  been  estimated  at  from  5  to  9 
per  cent. ;  but  some  of  the  sweet  ciders  of  France  do 
not  contain  even  2  per  cent,  of  alcohol.  They  contain 
also  acids,  chiefly  malic,  extractives,  and  salts.  The 
alkaline  salts,  malates,  carbonates,  and  phosphates 
impart  diuretic  properties,  and  those  of  potash  some 
slight  aperient  effects. 

It  has  been  suggested  by  Denis-Dumont,  of  Caen, 
that  the  diuretic  properties  of  cider  render  it  a  useful 
beverage  for  the  gouty  and  those  who  suffer  from  uric 
acid  deposits.  Made  into  "  cup  "  with  soda-water,  it 
is,  no  doubt,  a  refreshing  and  wholesome  beverage ; 
but  as  it  is  apt  to  undergo  acetous  fermentation,  care 
must  be  taken  that  it  is  "  sound,"  or  it  may  give  rise 
to  colic  and  diarrhoea. 

Beer. — This  popular  and  ancient  beverage  is,  as 
is  well  known,  a  fermented  infusion  of  malt  flavoured 
with  the  bitter  extractive  of  the  hop. 

In  the  process  of  "  malting,"  barley  is  caused  to^ 
germinate  under  the  influence  of  warmth  and  moisture ; 
a  ferment  diastase  is  developed  during  germination, 
and  this  ferment  converts  the  starch  of  the  grain  into 
dextrin  and  sugar ;  it  is  thus  rendered  capable  of 
yielding  a  saccharine  infusion  suitable  for  alcoholic  fer- 
mentation. The  malt  must  be  dried,  and  this  drying 
is  effected  at  different  temperatures.  When  dried  at 
a  comparatively  low  temperature,  e.g.  below  140°  F., 
a  pale  malt  is  produced  which  is  used  in  brewing 
ale.  Malt  dried  at  a  higher  temperature,  and  so 
blackened  and  burnt,  is  used  for  brewing  porter  and 
stout. 

It  is  unnecessary  here  to  describe  the  process  of 
brewing.  It  is  sufficient  to  say  that  the  infusion  of 
malt  is  termed  "  wort,"  and  contains  in  solution 
sugar,  dextrin,  albuminates,  diastase,  and  salts.     To 


Chap.  V.J 


Beverages  : — Beer. 


127 


this  "sweet  wort  "hops  in  suitable  quantity  are  added, 
the  liquid  is  then  boiled,  cooled,  and  placed  in  vats 
for  fermentation  with  yeast.  The  alcoholic  strength 
of  the  beer  depends  on  whetl^er  a  strong  or  weak  wort 
is  used.  The  more  concentrated  the  wort  the  stronger 
will  be  the  beer  brewed  from  it.  In  the  preparation 
of  beer  other  starch-containing  substances  capable  of 
being  converted  into  sugar  by  the  action  of  diastase 
may  be  used,  such  as  wheat,  rice,  and  ixttatoes.  Alcohol 
and  carbonic  acid  are  formed  during  the  fermenta- 
tion of  the  wort.  The  greater  part  of  the  latter 
escapes,  but  enough  is  retained  to  give  an  agree- 
able flavour  to  the  beverage.  Tliere  are  other  details 
necessary  to  be  attended  to  in  the  preparation  of 
the  various  kinds  of  beer  with  which  we  are  not 
concerned. 

The  chemical  composition  of  beer  is  somewhat 
complex ;  besides  water  and  alcohol,  it  contains  sugar, 
dextrin,  albuminates,  aromatic,  bitter  and  colouring 
matter,  salts,  and  a  varying  amount  of  acetic  and 
carbonic  acid. 

The  following  analysis  of  German  beers  is  adopted 
from  Konig : — 


Mild  (Winter)  Beer 

,,  (Summer)  „ 
Strong  (double  „ 
Porter 


Water. 

Carbo- 
nic 

Alcohol 

Albu- 

Extrac- 

Acid. 

3-21 

1 

91-81 

0-23 

0-81 

4  99 

90-71 

0-22 

3-68 

0-49 

5-61 

88-72 

0-25 

4-07 

0-71 

7-23 

88-52 

0-21 

516 

0-73 

6-32 

Ash. 


0  20 
0-22 
0-27 
0-27 


By  keeping,  the  amount  of  alcohol  gradually  in- 
creases and  that  of  extractives  diminishes ;  "  old  ales  " 
are  therefore,  as  a  rule,  strong  ales.  The  colour  of  beer 
depends  on  the  temperature  at  which  the  malt  is 
dried,  also  the  longer  the  wort  is  boiled  the  darker 
it  becomes. 

The  average  percentage  amount  of  alcohol,  extrac- 


128 


Food  in  Health. 


[PartL 


tives,  and  ash  in  various  well-known  beers    is  thus 
given  by  Dujardin-Beaumetz  after  Girard  and  Pabst.* 


Alcohol, 

Extractives 

Ash. 

English  Beer  (for  exportation)... 
London  Porter    ... 

7-3 

5-2 

5-9 
64 

0-35 
0-32 

Strasbourg-  Beer 

4-7 

4-65 

0-32 

Bavarian      „       

4-5 

7-2 

0-2D 

Saxony         „       

Bohemian     „ 

3-7 
3-6 

5-8 
4-7 

0-2o 
0-20 

Vienna         „ 

3-5 

6-1 

0-20 

The  amount  of  alcohol  by  volume  in  diflerent 
beers  may  vary  by  as  much  as  from  1  to  10  per  cent. 
Scotch(Edinburgli)  alecontainsas  much  as 8"5 per  cent. 
of  alcohol.  The  free  acidity  (chiefly  acetic  acid  with 
small  quantities  of  lactic,  malic  and  gallic  acids)  ranges 
from  18  to  45  grains  per  pint.  Most  beers  contain  a 
small  amount  of  albuminous  substances,  not  more  on 
an  average  than  0"5  per  cent.  The  salts  consist  of 
earthy  phosphates  and  alkaline  chlorides  and  phos- 
phates. Some  of  the  dark  beers  and  porters  contain 
caramel.  Free  carbonic  acid  exists  in  beer  in  about 
the  proportion  of  1|  cubic  inch  per  ounce. 

It  has  been  calculated  that  on  an  average  a  pint 
(20  oz.)  of  beer  contains — 

Alcohol       1  oz. 

Extractives — Dextrin,  Sugar       ...  12oz. 

Free  Acid 25  grains. 

Salts  ...         ...         ...         ...  13  grains. 

The  peculiar  aromatic  and  bitter  flavour  of  beer 
is  due  to  the  hop  extractives  it  contains. 

The  extractive  matters  derived  fro./i  the  malt,  and 
consisting  chiefly  of  sugar  and  other  carbohydrates, 
vary  from  5  to  nearly  15  per  cent.,  and  are  most 
abundant  in  stout,  porter,  and  sweet  ales,  and  least 
so  in  light,  bitter  beer. 

*  "  L'Hygiene  Alimeutairc  des  Boisioue." 


Chap,  v.]  Beverages  : — Beer.  ,  129 

Beer  is  not  merely  a  tonic  and  stimulating  alcoholic 
beverage,  it  also  contains  a  certain  amount  of  nutri- 
ment in  the  form  of  extractives,  chiefly  carbohydrates, 
with  a  small  quantity  of  albuminates ;  so  that,  when 
taken  habitually,  it  tends  to  induce  a  state  of  fulness 
and  plethora  of  the  system,  and  a  disposition  to  grow 
fat.  It  has  been  suggested  that  this  is  to  some  extent 
due  to  its  exercising  a  slight  interference  with  the 
metabolism  both  of  the  fatty  and  nitrogenous  tissues. 
Dujardin  -  Beaumetz  considers  that  it  assists  the 
digestion  of  alimentary  carbohydrates  through  the 
influence  of  a  certain  amount  of  diastase  in  it.  Light 
beers  in  which  the  bitter  principles  predominate  and 
the  extractives  are  small  in  amount,  no  doubt  act  as 
stomachics  and  tonics. 

It  has  been  remarked  that  great  l^eer-drinkers  are 
subject  to  heaviness  and  drowsiness,  and  these  effects 
are  referred  to  the  narcotic  principles  in  the  hops 
(lupulin) ;  but  Ranke  has  suggested  that  it  is  caused 
in  part  by  the  potash  salts  in  it.  It  is  believed  that 
the  habitual  excessive  consumption  of  beer  may  intei'- 
fere  with  due  oxidation  and  elimination  to  such  an 
extent  as  to  lead  to  the  accumulation  in  the  system  of 
imperfectly  oxidised  products  such  as  oxalic  and  uric 
acids,  and  so  engender  biliousness  and  goutiness.  To 
avoid  such  possible  evils  the  quantity  consumed  daily 
should  not  exceed  a  pint  of  the  stronger  beers  or  two 
pints  of  the  weaker  ones.  Porter  appears  to  be  easier 
of  digestion  than  beer. 

Sir  William  Roberts's  observations  on  the  effects 
of  beer  on  salivary  and  peptic  digestion  showed  that 
"malt  liquors  hamper  salivary  digestion  exactly  in 
proportion  to  their  degree  of  acidity.  Sound  English 
beers  have  not  nearly  so  much  acidity  as  wines,  and 
they  interfere  comparatively  little  with  the  digestion 
of  starch ;  but  '  turned '  beer  is  highly  inhibitory." 
With  respect  to  peptic  digestion,  malt  liquors  exerted 
a  retarding  effect  "  altogether  out  of  proportion  to 
their  percentage  of  alcohol."  In  large  qu.antities 
they  are  powerful  retarders  of  stomach  digestion,  in 
J 


130  Food  itf  Health,  [Parti. 

particular  of  farinaceous  foods.  "  But  in  more 
moderate  quantities — a  tumbler  or  so — especially  of 
the  lighter  beers,"  they  assist  digestion,  and  this  is 
particularly  the  case  when  the  beer  is  "  well  up,"  i.e. 
when  it  contains  a  considerable  amount  of  free 
carbonic  acid. 

It  is  greatly  to  be  regretted  that  in  the  intere.st 
of  temperance  amongst  the  poor,  no  generally  accept- 
able cheap  beverage,  somewhat  of  the  same  char- 
acter as  beer,  has  been  provided  for  common  con- 
sumption. We  add  a  recipe  for  such  a  beverage, 
which  we  obtained  from  the  wife  of  a  country  doctor, 
after  partaking  of  some  of  her  brewing,  which 
appeared  excellent : — Take  6  lbs.  of  raw  sugar,  5  ozs. 
of  hops,  4  ozs.  of  ginger,  boil  these  together  for  two 
hours  (the  hops  and  ginger  being  enclosed  in  bags) 
in  9  gallons  of  water.  Then  place  in  a  pan  to  cool, 
and  while  still  warm  add  2  tablespoonfuls  of  yeast ; 
next  morning  skim  off  the  yeast  and  put  into  a  barrel, 
and  allow  it  to  "  work  "  two  days  and  two  nights ; 
then  add  |  oz.  of  isinglass  and  bung  up  the  barrel. 
After  standing  for  three  days  it  will  be  fit  for  use. 
The  addition  of  a  little  burnt  sugar  (caramel)  would 
give  it  an  attractive  colour. 

Condiments. 

Condiments  are  employed  for  the  pui"pose  of  giving 
flavour  and  relish  to  food,  to  excite  appetite  and  to 
promote  digestion.  They  greatly  increase  the  pleasur  es 
of  feeding,  and  by  their  stimulating  properties  tliey 
promote  the  digestive  secretions  and  excite  the 
muscular  contractions  of  the  alimentary  canal.  Many 
are  distinctly  antiseptic  and  carminative. 

The  most  important  and  most  extensively  used 
is  common  salt.  Sir  William  Roberts  asks  the  question, 
"  Why  do  we  use  so  much  salt  with  our  food  % 
Animals  in  a  state  of  nature  require  none."  He 
concludes  that  it  is  because  in  our  elaborate  methods 
of  cooking  and  preparing   food    they    are   deprived 


Chap,  v.]  Condiments.  131 

of  most  of  their  saline  ingredients.  "  Salt  must 
therefore  be  supplied  artificially  to  make  up  the 
defect,  and  to  restore  to  the  food  so  treated 
that  sapidity  and  salinity  of  which  it  has  in  part 
been  deprived."  Besides  giving  relish  to  food, 
salt  aids  digestion  by  promoting  the  secretion  of 
gastric  juice,  and  thereby  furthering  the  solution  of 
albuminous  substances.  According  to  Voit,  the  pre- 
sence of  salt  favours  the  disintegration  of  albumen  in 
the  body,  and  accelerates  the  interchange  of  juices  and 
augments  tlie  renal  secretion. 

Vinegar  is  also  an  important  condiment  extensively 
used  to  give  an  acidulous  flavour  to  many  articles  of 
food,  and  also,  for  its  antiseptic  properties,  to  preserve 
food.  Sir  William  Roberts  found  that  it  had  a  very 
powerful  retarding  effect  on  salivary  digestion,  and  he 
cautions  persons  with  weak  digestion  to  be  very 
sparing  in  its  use.  Bauer  also  cautions  against  an 
excessive  use  of  vinegar  as  it  "  leads  to  a  high  degree 
of  ansemia  and  emaciation,  since  the  acid  lessens  the 
alkalinity  of  the  blood  and  the  number  of  the  blood 
corpuscles."* 

Many  substances  used  as  condiments  contain 
small  quantities  of  ethereal  oils  and  other  aromatic 
substances — as  mustard,  pepper,  horse-radish,  ginger, 
nutmeg,  cinnamon,  cloves,  allspice,  saffron,  vanilla, 
mint,  thyme,  fennel,  sage,  parsley,  garlic,  etc.,  etc. 

Many  of  these,  by  conferring  agreeable  flavours 
and  by  their  warm  carminative  properties  promote 
appetite  and  assist  digestion ;  but  their  excessive  use 
is  calculated  to  excite  irritation  and  disorder  of  the 
■digestive  organs. 

•  "  Dietary  of  the  Sick." 


3  2 


132 


CHAPTER    VI. 

THE    ANNEXATION     OF     FOOD  :     ITS     DIGESTION,     ASSIMI- 
LATION,   AND    UTILISATION. 

In  this  chapter  we  shall  proceed  to  consider  the  pre- 
parations and  transformations  which  the  different 
\arieties  of  alimentary  substances  must  undergo 
within  the  body  in  order  that  they  may  be  assimi- 
lated, annexed,  or  otherwise  utilised  according  to 
their  several  functions  in  nutrition. 

The  first  change  which  the  food  experiences  in 
order  to  fit  it  for  annexation  and  utilisation  is  in  the 
mouth,  where  it  undergoes  mechanical  subdivision  in 
the  process  of  mastication,  as  well  as  admixture  with 
the  secretion  of  the  salivary  and  other  glands  of  the 
mouth.  The  mechanical  division  which  the  food 
undergoes  in  the  mouth  is  an  exceedingly  important 
preparatory  step  to  the  further  action  of  the  digestive 
juices  upon  it,  as  it  multiplies  the  surfaces  of  contact 
and  increa.ses  its  permeability  to  the  digestive  fluids. 
By  simultaneous  commingling  with  the  frothy  saliva 
a  certain  amount  of  air  is  blended  with  the  food, 
which  also  renders  it  lighter  and  more  porous  and. 
more  accessible  to  the  gastric  and  intestinal  juices. 

Admixture  with  the  saliva  is  also  attended  by  a 
chemical  action  on  the  carbohydrates  or  starchy  food 
substances.  Through  the  agency  of  a  diastasic  fer- 
ment contained  in  the  saliva,  to  which  the  name  of 
ptyaliii  is  given,  the  insoluble  starch  is  converted  into 
soluble  dextrin,  and  subsequently  into  maltose,  a  form 
of  sugar  which  is  distinguished  from  grape-sugar  by 
containing  one  molecule  less  of  water.  In  the  small 
intestines  the  maltose  is  converted  into  glucose. 


Chap.  VI.]  Action  OF  the  Saliva.  133 

Plyalin  belongs  to  the  group  of  unorganised  fer- 
ments, and,  even  when  present  only  in  very  minute 
quantity,  it  causes  starch  to  take  up  the  elements  of 
water  and  become  soluble,  undergoing  itself  no  essen- 
tial change  in  the  process.  Saliva  acts  but  slowly 
on  raw,  unboiled  starch,  because  the  starch-grains 
consist  of  granulose,  or  starch  enclosed  in  coats  of 
cellulose,  and  cellulose  appears  to  be  unaffected  by 
saliva.  When  the  starch  is  boiled,  the  starch-grains 
swell  up,  the  cellulose  envelopes  are  ruptui'od,  and 
thus  the  diastasic  action  of  the  ptyalin  can  take 
efi'ect.  Hence  the  necessity  of  thoroughly  boiling  all 
starchy  food  or  raising  it  to  a  high  temj^erature. 

During  the  early  months  of  infant  life  the  salivary 
glands  are  very  imperfectly  developed,  and  it  is  not 
therefore,  advisable  to  give  starchy  food  to  young 
infants.  Saliva  acts  best  in  an  exactly  neutral 
medium  ;  but  it  also  acts  in  an  alkaline  and  even 
in  a  slightly  acid  fluid.  Its  action  is,  however,  arrested 
or  prevented  by  a  strong  acid  ;  so  that  when  the  con- 
tents of  the  stomach  are  decidedly  acid,  and  especi- 
ally when  it  contains  free  hydrochloric  acid,  the 
action  of  the  saliva  on  starch  is  arrested  when  the 
food  reaches  that  organ.  If  the  acidity  be  neutral- 
ised, the  action  is  resumed. 

Bauer  suggests  that  the  chemical  action  of  saliva 
in  digestion  is  infinitely  less  than  might  at  first  sight 
Vje  supposed,  as  the  food  remains  so  short  a  time  in 
the  mouth,  and  the  transformation  of  starch  into 
sugar  is  ari-ested  by  the  acid  gastiic  juice,  and  that 
its  chief  use  is  to  soften,  moisten,  and  aid  in  the 
mechanical  subdivision  of  the  food-mass,  and  also,  by 
covering  it  with  mucus,  to  enable  it  to  be  easily 
swallowed.  Substances  soluble  in  water  are  dissolved 
by  the  saliva,  and  the  sapid  matters  are  tlius  brought 
into  contact  with  the  end-organs  of  the  nerves  of 
taste. 

Sir  William  Roberts  observes  with  regard  to 
Salivary  digestion  that,  as  the  time  for  it  is  brief,  "  to 
be  of  any  avail  the  action  must  be  r.ipid."     He  thinks 


134  Food  in  Health.  (Pani. 

that  '*  the  exceptional  richness  in  diastase  of  human 
bahva  "  is  lemaikable,  and  that  it  has  "  special  rela- 
tion to  the  habit  man  has  acquired  of  cooking  his 
food.  Salivary  diastase  is  powerless  on  raw  starch, 
but  it  acts  energetically  on  starch  which  has  been 
changed  to  a  state  of  jelly  or  mucilage  by  previous 
boiling  or  baking.  And  if  we  consider  how  large  a 
part  of  our  food  consists  of  bread  and  other  cooked 
farinaceous  articles,  the  importance  of  an  exceptional 
salivary  power  will  at  once  appear."  The  initial  act 
is  the  transformation  of  this  "  solid  or  semi-solid 
coherent  starch-jelly  into  a  running  liquid.  Such 
articles,  as  bread,  pastiy,  and  doughy  puddings  are 
altered  considerably  even  by  a  brief  contact  with 
saliva.  Their  texture  is  lendered  loose  and  more 
penetrable,  and  this  change  greatly  facilitates  the 
subsequent  task  of  the  gastric  juice."  * 

In  febrile  and  other  morbid  states  the  saliva  may 
assume  an  acid  instead  of  the  normal  alkaline  reac- 
tion. This  is  due  to  fermentative  changes  set  up  by 
low  organisms  in  the  mouth.  The  salivary  secretion 
is  often  also  diminished,  and  the  mouth  becomes  "  dry 
and  parched;"  or  the  mucus  becomes  viscid  and 
tenacious  and  the  mouth  "clammy."  This  condition 
is  favourable  to  the  development  of  acid  and  fuetid 
decompositions. 

The  conclusions  deduced  by  Sir  William  Roberts, 
from  his  experiments  on  the  influence  of  certain  fami- 
liar "  food  accessories  "  on  salivary  digestion,  may  be 
suitably  summarised  here  : — First,  with  regard  to 
ardent  spirits,  such  as  whisky,  gin,  and  brandy,  he 
found,  when  used  with  moderation  and  well  diluted, 
that  tliey  promoted,  rather  than  retarded,  salivary 
digestion  by  causing  an  increased  flow  of  saliva. 
But  the  proportion  must  not  exceed  5  per  cent., 
and  gin  seems  to  be  preferable  to  either  brandy 
or  whisky.  In  whisky  and  brandy  thei-e  are  certain 
ethei-s  and  volatile  oils,  and  in  the  latter  a  trace 
of  tannin,  and  these  appear  to  exert  an  intensely 
•  "Dietetics  and  I>yspei)sia. ' 


Chap.  VI.]  Gastric  Digestion.  135 

retarding  influence  on  salivary  difjestion.  And  the 
stronger  mixtures  of  all  these  decidedly  retard 
salivary  digestion.  With  regard  to  wines,  it  was 
found  that  even  small  quantities  of  such  wines  as 
sherry,  hock,  claret,  and  port  exercised  a  powerful 
retarding  influence  on  salivary  digestion,  due,  not 
to  the  alcohol,  but  to  the  acid  they  contain  ;  for 
when  this  was  neutralised  by  the  addition  of  some 
alkaline  effervescing  water,  the  disturbing  effect  on 
salivary  digestion  was  completely  removed.  The 
influence  of  acids  in  arresting  or  i-etarding  salivary 
digestion  is  important  in  connection  with  the  dietetic 
use  of  vinegar,  pickles,  salads,  etc.  In  the  case  of 
vinegar,  it  was  found  that  1  part  in  5,000  sensibly 
retarded  this  process ;  so  that  when  acid  salads  are 
taken  together  with  bread,  the  effect  of  the  acid  is 
to  prevent  any  salivary  digestion  of  the  bread.  As  to 
malt  liquors,  if  they  are  free  from  acidity  they 
interfere  but  little  with  salivary  digestion ;  but  it  is 
otherwise  if  they  ax-e  acid.  Pure  water  charged  with 
carbonic  acid  exercises  a  considerable  retarding 
influence  on  salivary  digestion  ;  but  if  it  contains  an 
alkaline  carbonate,  the  presence  of  the  alkali  removes 
this  retarding  effect.  Tea  was  also  found  to  exert  a 
powerful  retarding  influence  on  salivary  digestion,  duo 
to  the  tannin  it  contains  ;  coflTec  and  cocoa  a  compara- 
tively feeble  one. 

The  food  when  it  reaches  the  stomach  encounters  the 
acid  gastric  juice,  and  by  the  agency  of  this  digestive 
fluid  the  insoluble  albuminates  become  converted  into 
soluble  pe;;io?ies.  This  change  is  effected  by  the  agency 
of  a  "hydrolytic"  ferment,  termed  -pepshiy  which  the 
gastric  juice  contains,  together  with  free  hydrochloric 
acid.  The  acidity  of  the  gastric  juice  is,  in  health, 
not  so  great  as  is  generally  believed  ;  indeed,  its  acid 
reaction  is  but  slight,  as  the  hydrochloric  acid  it  con- 
tains enters  into  combination,  for  the  time  being,  with 
pepsin  and  albuminates,  and  then  no  longer  gives  an 
acid  reaction.     The  amount  of  free  hvdrochloric  acid  in 


136  Food  in  Health.  i,part  i. 

fjastric  juice  lias  been  estimated  at  0*2  to  0  3  part  in 
1,000.*  {Landois.)  Lactic  acid  is  also  found  in 
gastric  juice,  but  this  arises  from  the  fermentation 
of  carbohydrates ;  for  there  are  two  other  ferments 
yielded  by  the  gastric  juice — a  lactic  acid  ferment  and 
a  milk-curdling  ferment. 

The  carbohydrates  undergo  still  further  conversion 
into  dextrin  in  the  stomach  through  the  continued 
action  of  the  saliva  swallowed,  but  whether  their  con- 
version into  sugar  is  or  is  not  arrested  in  the  stomach 
is  as  yet  undetermined.  The  finely  divided  mixture 
of  food  and  gastric  juice  found  in  the  stomach  is 
spoken  of  as  chyme.  The  action  of  gastric  juice 
on  albuminates  is  first  to  cause  them  to  swell  up, 
and  finally  to  dissolve  them  more  or  less  completely. 
There  would  ajipear  to  be  certain  stages  in  this 
process.  The  large  and  comj)licated  proteid  molecule 
is  split  up  by  a  process  of  hydration  into  simpler  onesi. 
The  first  stage  is  the  formation  of  syntonhi  or  acid- 
albumen,  or  para-peptone.  This  has  the  property  of 
being  soluble  in  acids,  but  it  is  again  precipitated  on 
neutralising  the  solution.  The  next  step  is  the  forma- 
tion of  hemi-albumose  or  jn'O-peptone.  This  is  not 
coagulated  by  heat  and  is  soluble  in  water.  It  is 
precipitated  by  nitric  acid,  but  the  precipitate  is 
dissolved  on  heating  and  falls  down  again  on  cooling. 
Finally,  by  the  continued  action  of  the  gastric  juice, 
the  pro-peptone  passes  into  true  soluble  peptone.  Its 
formation  is  due  to  the  taking  up  of  a  molecule  of 
water,  under  the  influence  of  the  hydrolytic  ferment 
pepsin.  The  greater  the  amount  of  pepsin,  within 
certain  limits,  the  more  rapidly  does  the  solution  take 
jjlace.  The  pepsin  suffers  scarcely  any  change ;  it 
would  seem,  however,  that  some  of  it  is  used  up  in 
the  process  of  digestion,  but  the  chief  loss  is  due  to 
its  passing,  from  time  to  time,  with  the  chyme  into 
the  small  intestine.  Sir  William  Roberts,  from  obser- 
vations on  peptic  digestion,  out  of  the  body,  infers  that 

*  Eichet's  estimate  is  much  higher,  uamely,  017  per  cent. 
"Z>u  Sue  Oastrique." 


Chap,  vi.i  Peptones.  137 

"  the  speed  of  digestion  is  roughly  proportionate  to 
the  amount  of  pepsin  in  the  digesting  mixture.  The 
more  pepsin,  the  greater  is  the  speed  of  digestion — 
without  any  limit  on  either  side.  And  we  should 
probably  see  ...  if  it  were  possible  to  arrange  the 
experiment  so  as  to  eliminate  all  interfering  couditions, 
the  speed  of  peptic  digestion  would  be  found  to  be 
exactly  proportional  to  the  quantity  of  pepsin  con- 
tamed  in  the  digesting  mixture."  Albuminous  sub- 
stances entering  the  stomach  in  solution  are  not  first 
coagulated,  as  used  to  l>e  taught,  before  they  are 
converted  into  syntonin,  except  in  the  instance  of 
casein,  which  is  first  coagulated  and  afterwards 
dis.solved.  It  has  been  suggested  that  coagulated 
albumen  may  be  regarded  as  the  anhydride  of  the  fluid 
form  and  the  latter  as  the  anhydride  of  peptone  ;  this 
view,  therefore,  represents  the  peptones  as  the  highest 
degi'ee  of  hydration  of  the  albuminates. 

The  true  peptones  have  remarkable  characters  and 
jjroperties  by  which  they  differ  greatly  from  ordinai-y 
soluble  albumen.  They  are  not  coagulated  by  heat, 
or  by  nitric  acid,  or  by  acetic  acid,  and  potassium 
ferro-cyanide.  They  diffuse  easily  through  animal 
membranes.  They  have  a  cheesy  taste,  while 
albumen  and  albumose  are  tasteless. 

The  destination  of  the  peptones,  after  absorption 
into  the  blood,  is  doubtless  to  replace  the  albuminous 
substances  consumed  in  the  organism. 

Gelatin  and  gelatin-yielding  substances  are  also 
digested  by  the  gastric  juice,  and  gelatin  loses  its 
property  of  solidifying  in  the  cold. 

The  gelatin- peptones  are  quite  different  from  the 
true  peptones,  although  they  share  with  them  the 
properties  of  solubility  in  water  and  diffusibility 
through  membrane. 

It  is  interesting  and  important  to  notice  the 
changes  that  milk  undergoes  in  the  stomach.  On 
entering  the  stomach  the  casein  coagulates  and  en- 
tangles with  it  some  of  the  fat  globules.  The  free 
liydrochloric    acid,  by  neutralising    the  alkali  which 


138  Food  in  Health.  [Pan  i. 

keeps  the  casein  in  solution  in  milk,  is  adequate  to 
produce  this  effect,  but  the  gastric  juice  contains  also, 
besides  pepsin,  a  milk-curdling  ferment  which  pre- 
cipitates casein  either  in  neutral  or  alkaline  solutions. 
It  is  this  ferment,  under  the  name  of  rennet  (an  in- 
fusion of  the  fourth  stomach  of  the  calf  in  brine), 
which  is  used  to  coagulate  casein  in  the  manufacture 
of  cheese.  The  casein  is  in  the  stomach  subsequently 
converted  into  syntonin,  and  finally  into  a  true 
peptone. 

There  is  also  a  lactic  acid  ferment  in  the  stomach 
which  changes  a  portion  of  the  milk-sugar  into  lactic 
acid.  A  part  of  the  milk-sugar  is  converted  in  the 
stomach  and  intestine  into  grape-sugar. 

It  is  necessary  for  the  proper  performance  of 
gastric  digestion  that  the  food  should  be  kept  for  a 
considerable  time  in  the  stomach  submitted  to  the 
sort  of  churning  movement  imparted  to  the  food-mass 
by  the  contraction  of  its  muscular  walls.  In  tliis 
way  the  food  is  thoroughly  mixed  up  with  the  gastric 
juice,  the  chyme  being  prevented  from  escaping  into 
the  duodenum  by  the  contraction  of  the  pylorus  ;  this 
after  three  or  four  hours  relaxes,  and  the  acid  chyme 
passes  out  of  the  stomach  into  the  small  intestine. 
Do  fats  undergo  any  change  in  the  stomach  1  They 
are  said  to  undergo  partial  decomposition  with  the 
formation  of  a  small  quantity  of  fatty  acids  which  are 
of  use  in  emulsifying  the  rest  of  the  fat ;  but  their 
real  digestion  takes  place  lower  down  in  the  alimen- 
tary canal. 

Peptones  can  be  produced  outside  the  body  by 
dissolving  albuminous  substances  in  artificial  gastric 
juice.  Such  products  often  possess  a  disagreeable 
bitter  taste,  the  cause  of  which  is  not  thoroughly 
understood.  It  has  been  suggested  that  it  is  due 
to  the  formation  of  an  alkaloid — of  the  nature  of  a 
ptomaine — developed  during  the  decomposition  of 
albuminous  matter.  These  artificially-produced  p<!p- 
tones  have  been  regarded  as  calculated  to  render  great 
service  in  invalid  feeding.     Whether  they  can  fulfil 


Chap.  VI.)  Peptones.  139 

all  the  functions  in  the  body  of  albuminous  sub- 
stances, and  contribute,  like  them,  to  the  repair  of 
the  nitrogenous  tissues,  has  been  warmly  discussed. 
It  is  admitted  that  there  is  no  necessity  that  dissolved 
albuminous  substances  should  be  transformed  into 
peptones  in  order  to  be  absorbed ;  they  can  certainly 
be  absorbed  without  undergoing  such  transformation. 

It  is  also  known  than  an  increased  secretion  of 
urea  appears  after  the  administration  of  peptones,  just 
as  it  does  after  the  ingestion  of  unaltered  albumen, 
and  that  the  chemical  composition  of  peptones  differs 
little  from  that  of  ordinary  albuminous  bodies. 

But  Brucke  has  maintained,  in  opposition  to  those 
who  assert  that  peptones  perform  all  the  functions  of 
proteids,  that  the  absorption  of  some  unchanged 
albumen  is  necessary  and  that  only  this  is  capable  of 
forming  organic  albumen,  and  that  the  peptones  after 
undergoing  a  re-conversion  into  albumen  are  wholly 
metabolised  as  such.  This  is  the  view  to  which  Bauer 
seems  to  lean.*  "An  organism,"  he  says,  "could 
with  peptones  alone,  and  combined  only  with  the 
necessary  non-nitrogenous  food  stutfs,  be  kept  alive 
only  for  a  limited,  albeit  a  fairly  long  space  of  time ; 
but  for  its  continued  maintenance  the  addition  of  so 
much  unaltered  albumen  as  is  necessary  for  the  repair 
of  the  tissues  would  be  required.  At  the  same  time 
it  is  not  improbable  that  a  given  weight  of  {)eptone 
is  perfectly  equivalent  for  purposes  of  metabolism  to 
an  equal  amount  of  albumen,  so  that  its  albumeii- 
sparing  action  far  exceeds  that  of  gelatin. 

"  It  is  clear  also  that  the  peptones,  even  if  in 
further  researches  they  should  bo  found  not  to  be 
available  for  tissue  formation,  may  yet  bo  very  valu- 
able nutriments  for  the  sick,  being  capable  of  re- 
placing albuminous  nutrition  for  months  together, 
aud  presenting  the  manifest  advantage  of  being  ea'^ily 
and  immediately  absorbed.  A  relatively  small  addi- 
tion to  the  food  ot  unaltered  albumen  would  be  neces- 
sary in  order  to  obviate  the  waste  of  albumen  in  the 
•  "Dietary  of  the  Sick." 


I40  Food  in  Health.  [Parti. 

body  as  well  as  to  attain  an  increase  of  weight.  All 
clinical  experience  in  peptone  feeding  in  the  i)ast  is 
capable  of  the  same  interpi-etation." 

It  is  a  curious  and  interesting  circumstance  that 
when  peptones  are  injected  into  the  general  circula- 
lation  they  act  as  poisons,  and  this  fact  has  naturally 
led  to  the  inquiry  why  it  is  that,  in  health,  the  pep- 
tones in  the  intestine  do  not  pass  into  the  general 
circulation  and  exert  their  poisonous  influence  on  the 
nervous  system.  To  this  inquiry  no  satisfactory 
answer  can  at  present  be  given.  As  a  rule,  the 
peptones  disappear  from  the  portal  blood  before  it 
reaches  the  general  circulation ;  indeed,  very  little, 
if  any,  peptones  can  be  found  in  it  before  it  reaches 
the  liver.  Although  it  has  not  yet  been  discovered 
where  the  peptones  undergo  this  remarkable  change 
which  renders  them  fit  for  appropriation  as  nutriment, 
it  has  been  suggested  that  the  liver  may,  to  some 
extent,  serve  the  purpose  of  prev(;nting  any  peptones 
from  reaching  the  general  circulation  which  may  have 
escaped  transformation  in  the  blood  of  the  portal 
system. 

Dujardin-Beaumetz  calls  attention  to  the  ditl'erence 
observable  in  the  various  peptones  that  are  found  in 
commei'ce  ;  "some  are  acid,  some  neutral  ;  some  are 
liquid,  some  solid ;  and  their  chemical  reactions  even 
are  difteient."  He  regards  the  question  of  peptones 
as  a  "  very  complex  "  one.  The  dry  peptones  he 
con.siders  preferable  to  the  liquid  one.s.  He  calls  at- 
tention to  their  disagreeable  taste  being  obje  tionable 
to  many  invalids,  and  he  suspects  the  more  agreeable- 
tasting  preparations  of  being  largely  adulterated  witli 
gelatin.  Instead  of  promoting  the  secretion  of 
gastric  juice,  he  has  found  that  they  retard  it.  Their 
chief  value  is,  he  maintains,  in  rectal  alimentation. 

Attempts  have  been  made  from  time  to  time  to 
estimate  the  relative  digestibility  of  diflerent  kinds 
of  foods  in  the  stomach ;  but  this  is  a  question 
extremely  difficult  to  resolve,  as  it  is  complicated  by  a 
variety  of  changing  circumstances.     The  activity  of 


Chap.  VI.]     Duration  OF  Gastric  Digestion.    141 

the  digestive  organs  is  subject  to  great  variations 
at  different  times  and  in  difierent  individuals.  The 
various  modes  of  cooking  or  otherwise  preparing  the 
food  may  cause  it  to  offer  very  varying  degrees  of 
resistance  to  the  action  of  the  gastric  juice  at  different 
periods.  One  of  the  most  important  conditions  is,  no 
doubt,  the  state  of  mechanical  subdivision  to  which 
the  food  is  reduced  when  it  reaches  the  stomach 
Fish  and  chicken  (the  more  delic^ate  parts,  as,  e.g. 
the  breast)  are  more  digestible  than  mutton,  and 
mutton  is  more  digestible  than  beef;  and  these  differ- 
ences are  due  to  the  different  degrees  of  resistance 
their  fibres  offer  to  disintegration.  Tlie  flaky  mus- 
cular masses  of  the  more  digestible  kinds  of  fish  are 
made  up  of  short  fibres,  easily  torn  apart  and  sepa- 
rated ;  the  flesh  of  the  chicken  is  composed  of  shorter 
and  more  delicate  fibres  than  those  of  mutton,  and 
mutton  of  shorter  and  smaller  fibres  than  beef.  The 
muscular  fibres  of  different  parts  of  an  animal  differ 
also  greatly  in  their  size  and  delicacy  and  mode  of 
aggregation.  The  short  and  delicate-fibred  muscles 
of  the  chicken's  breast  are  more  easily  digested  than 
the  larger  and  tougher-fibred  leg  muscles.  Dr.  Beau- 
mont's observations  on  the  rate  of  digestion  of  various 
substances,  as  noted  by  him  in  the  celebrated  case  of 
Alexis  St.  Martin,  who  was  the  subject  of  a  ga.stric 
fistula,  have  been  repeatedly  quoted.  His  general 
conclusions  were  in  accord  with  those  of  common 
experience.  Animal  foods  were  more  easily  digested 
than  vegetable ;  the  latter  were  often  observed  to 
leave  the  stomach  in  an  undigested  state.  Fats  were 
highly  indigestible  in  the  stomach.  The  digestibility 
of  animal  flesh  was  seen  to  be  dependent,  to  a  great 
extent,  on  its  tenderness  and  facility  of  disintegra- 
tion ;  game,  for  instance,  was  the  most  digestible  of 
foods.  Salt  and  vinegar  appeared  to  promote  diges- 
tion. The  rapidity  with  which  a  meal  was  digested 
depended  on  the  quantity  as  well  as  the  quality  of 
the  food  and  the  condition  of  the  stomach  at  the 
time.     Three  and  a  half  hours  was  the  average  time 


142  Food  IN  Health.  [Parti 

it  took  to  digest  a  moderate  meal  of  bread  and  meat. 
Saturation  of  the  ingesta  with  fat  materially  inter- 
feres with  the  action  of  the  gastric  juice  upon  it. 
The  tender  cellulose  of  young  vegetables  is  much 
more  digestible  than  when  it  has  been  rendered 
woody  by  age.  Cooked  meat  is  more  digestible 
than  raw,  the  gastric  juice  penetrating  with  greater 
ease  between  the  fibres.  Hard-boiled  eggs  appear  to 
offer  mechanical  conditions  most  unfavourable  to  the 
action  of  the  gastric  juice.  Animal  gelatin  is  very 
readily  dissolved  in  the  stomach. 

The  duration  of  gastric  digestion  appears  to  vary 
between  very  wide  limits,  and  to  depend  on  indi- 
vidual peculiarity  and  many  other  circumstances. 
The  most  common  circumstances  which  retard  gastric 
digestion  are  :  excessive  quantity  of  food,  a  catarrhal 
condition  of  the  gastric  mucous  membrane,  the  pre- 
sence of  the  febrile  state,  hyper£emia  and  anaemia 
of  the  mucous  membrane  of  the  stomach  (both  of 
which  interfere  with  the  free  secretion  of  the  gastric 
juice);  certain  morbid  states  of  the  nervous  system 
also  diminish  the  secretion  of  gastric  juice.  A  de- 
ficiency of  free  acid  seems  even  of  more  importance 
than  a  deficiency  of  pepsin ;  and  it  is  probable  that 
this  is  a  common  condition  in  cases  of  acute  and 
chronic  gastric  catarrh.  It  is  also  noteworthy  that, 
although  the  quantity  of  the  normal  acid  needed  for 
active  digestion  may  be  deficient,  yet  there  may  be 
sour  eructations  and  other  symptoms  present  pointing 
to  the  abnormal  formation  of  other  acids,  due  to 
abnormal  fermentative  processes. 

Food,  of  course,  may  be  abnormally  retained  in 
the  stomach  by  any  obstruction  at  the  pylorus,  or 
by  defective  propelling  power  in  the  stomach  walls 
associated  with  dilatation  of  its  cavity  and  a  paretic 
condition  of  its  muscular  coats. 

Sir  William  Roberts's  experiments  on  the  influence 
of  certain  food  accessories  on  peptic  digestion  led  him 
to  the  following  conclusions  : — Ardent  spirits  retarded 
digestion  according  to  their  degree  of  concentration. 


Chap.  VI.)  Intestinal  Digestion.  143 

With  10  per  cent,  and  nnder  of  proof  spirit  there  was 
no  aj)preciable  retardation,  and  only  a  slight  retarda- 
tion with  20  per  cent. ;  but  with  large  percentages  it 
was  very  different,  and  with  50  per  cent,  the  digestive 
ferment  was  almost  paralysed.  Wines  and  beer  retard 
peptic  digestion  altogether  out  of  proportion  to  the 
quantity  of  alcohol  they  contain.  Port  and  sherry 
exercised  a  great  retarding  effect.  Tea  and  coffee 
exercise  a  remarkably  retarding  effect  on  stomach 
digestion  ;  strong  coffee  had  a  very  powei-ful  retarding 
effect.  Beef  tea  had  a  powerful  i-etarding  effect  on 
peptic  digestion,  apparently  due  to  the  salts  of  the 
organic  acids  contained  in  it.* 

The  food,  reduced  to  the  condition  of  chyme,  when 
it  passes  out  of  the  stomach  into  the  duodenum,  en- 
counters two  other  digestive  fluids — the  hile  and  the 
pancreatic  juice.  The  acid  chyme,  meeting  with 
those  alkaline  fluids,  loses  its  acidity,  and  the  further 
action  of  the  pepsin  on  the  albuminates  is  suspended. 
The  pancreatic  juice  is  one  of  the  most  important 
iligestive  fluids  in  the  body,  and  it  is  the  most  ener- 
getic and  most  general  in  its  action  of  all  the  digestive 
juices,  and  contains  no  less  than  four  hydrolytic  fer- 
ments :  (1)  Amylopsin,  which  seems  to  be  identical 
with  the  ])tyalin  of  the  saliva,  but  is  much  more 
energetic  than  it,  and  can  transform  raw  as  well  as 
boiled  starch  into  sugar.  At  the  temperature  of  the 
body  the  change  is  effected  almost  at  once.  Even 
cellulose  is  said  to  be  dissolved  by  it,  and  gum 
changed  into  sugar.  This  ferment  is  absent,  accord- 
ing to  Korowin,  from  the  pancreas  of  new-born 
children.  (2)  Trypsin,^  which  digests  albuminates, 
changing  them,  first,  into  a  globulin-like  substance, 
then  into  pro-peptone  or  albumose,   and  finally  into 

•  "  Dietetics  and  Dyspepsia." 

t  It  is  a  remarkable  circumstance  that  the  juice  cf  the  green 
fruit  of  the  papaya  tree,  or  Carica  papaya,  possesses  digestive 
propeiiies,  due  to  the  presence  of  a  peptonising  ferment  closely 
related  to  tryptin,  and  termed  earicin  or  papain. 


144  Food  in  Health.  [Pani. 

true  peptone  like  the  pepsin-peptones,  and  sometimes 
termed  tryptone.  Trypsin  is  destroyed  when  it  en- 
counters pepsin  and  hydrochloric  acid  together ;  so 
that  it  is  useless  administering  trypsin  by  the  mouth, 
as  it  would  be  destroyed  in  the  stomach.  (3)  Afat- 
splittivg  ferment,  steapsin.  This  causes  neutral  fats 
to  appropriate  a  molecule  of  water  and  split  into 
glycerin,  and  their  corresponding  fatty  acids,  as,  e.g.  : 

Tristeavin.  Water.  Glyoerin.  Stearic  Acid. 

'(C57Hn«0«)  +  'mj)):=  (CJW   +  m^M- 

and  (4)  a  milk-curdling  fermpnt. 

The  pancreatic  juice  has  the  power  of  forming 
a  fine  permanent  emulsion  with  fats.  In  this  j)rocess 
the  fats  are  subdivided  into  exceedingly  minute  par- 
ticles, in  which  form  they  can  be  taken  up  by  the 
lacteals.  The  fatty  acid,  set  free  by  the  fat-splitting 
ferment,  enables  the  alkaline  pancreatic  juice  at  once 
to  produce  an  emulsion,  for  the  presence  of  a  free 
fatty  acid  causes  emulsification  to  take  place  very 
rapidly. 

Putrefactive  bacteria  appear  to  find  in  the  pro- 
ducts of  pancreatic  digestion  an  extremely  favourable 
soil  for  their  development,  and  under  certain  circum- 
stances, when  pancreatic  digestion  is  prolonged,  will 
give  rise  to  the  production  of  most  foul  smelling 
substances,  the  chief  of  which  is  Indol  (CgH^N).  This 
may  readily  be  produced  during  pancreatic  digestion 
out  of  the  body  ;  and  the  same  thing,  no  doubt, 
occurs  occasionally  inside  the  body,  and  would  fre- 
quently occur  were  it  not  for  the  antiseptic  action 
of  the  bile.  When,  therefore,  the  flow  of  bile  into 
the  small  intestine  is  for  any  reason  hindered  or 
interrupted,  there  is  obvious  danger  of  such  putre- 
factive decomposition  occurring;  and  since  during 
putrefactive  decomposition  within  the  body  poisonous 
organic  alkaloids  may  be  formed,  there  is  the  risk 
of  actual  poisoning  by  the  absorption  of  such  alkaloids 
from  the  alimentary  canal. 

It  is  seen,  then,  that  the  pancreatic  juice  exerts  a 


C!inp.  VI.)  /VXCT/OXS    OF    THE    Bjl.E.  145 

solvent  digestive  action  on  all  classes  of  alimentary 
substances,  the  albuminates,  the  carbohydrates,  and 
the  fats.  Like  the  saliva,  it  converts  starch  into 
dextrin  and  sugar,  and  like  the  gastric  juice,  it  con- 
verts insoluble  albuminates  into  soluble  peptones. 

It  has,  however,  been  proved  that  the  bile  exeiis 
an  important  influence  in  the  absorption  of  fat,  and 
that  large  quantities  of  fat  can  be  absoi'bed  without 
the  presence  of  pancreatic  juice  in  the  bowel,  pro- 
vided only  there  be  a  free  intiow  of  bile ;  but  if  bile 
be  absent,  then  the  absorption  of  fat  is  to  a  very 
great  extent  interfered  with,  notwithstanding  the 
abundant  presence  of  pancreatic  juice ;  and  so  far 
from  pancreatic  juice  being  the  sole  agent  in  the 
digestion  of  fat  (as  was  once  taught),  it  is  only  when 
associated  with  bile  that  it  is  of  any  real  value.  "  So 
far  as  we  know  at  present,"  says  Bauer,  "  the  pan- 
creatic juice  alone,  without  the  presence  of  the  bile, 
can  efiect  the  absorption  of  but  a  fraction  of  the 
ingested  fat ;  nevertheless,  it  is  conceivable  that  the 
action  of  the  bile  in  the  assimilation  of  fat  may  be 
but  imperfectly  performed  without  the  co-operation 
of  the  pancreatic  juice.  Perhaps  the  true  state  of  the 
case  may  be,  that  while  a  moderate  admixture  of  fat 
with  the  food  may  be  absorbed  by  means  of  the  bile 
alone,  larger  quantities  cannot  be  without  the  aid  of 
pancreatic  juice  at  the  same  time." 

The  bile  is,  then,  an  important  agent  in  the  diges- 
tion and  absorption  of  fat.  It  aids  the  pancreatic 
juice  in  emulsifying  fat,  and  it  has  a  remarkable  power 
in  facilitating  the  passage  of  fat  through  animal 
membrane.  If  bile  be  absent  from  the  intestine,  a 
large  proportion  of  the  fatty  matters  of  the  food  pass 
away  undigested  in  the  evacuations.  The  whitish 
colour  of  the  stools  in  cases  of  obstructive  jaundice  is 
not  only  connected  with  the  absence  of  bile  pigment, 
but  is  also  due  to  the  presence  of  a  large  qiantity  of 
undigested  fat.  Bile  promotes  the  absorption  of  fats 
— 1st,  by  emulsifying  them,  so  that  the  fatty  par- 
ticles pass   more   readily   into  the  lacteals  ;  2nd,   by 

K 


146  Food  in  Health.  [Parti. 

moistening  ox  wetting  both  the  fat  granules  and  the 
pores  of  the  intestinal  villi  so  that  they  become 
easily  permeable ;  it  is  found  that  fat  filters  through 
a  membrane  moistened  with  bile  or  bile-salts  under  less 
pressure  than  when  moistened  with  water  or  saline 
solutions.  It  allows  diflfusion  to  take  place  between  a 
watery  fluid  and  a  fatty  fluid  by  acting  as  a  sort 
of  soa]>,  so  that  the  intervening  membrane  can  be 
moistened  by  both  fluids.* 

It  is  said  (Landois)  that  bile  also  contains  a  diasiasic 
ferment  capable  of  transforming  starch  into  sugar  and 
also  glycogen  into  sugar.  Another  function  of  the  bile 
is  that  it  stimulates  the  peristaltic  movements  of  the 
muscular  wall  of  the  intestine,  and  so  acts  as  a  sort  of 
natural  aperient ;  this  efl"ect  is  also  furthered  by  the 
amount  of  fluid  it  adds  to  the  faeces.  The  bile  acts 
also  as  an  antiseptic,  and  prevents  putrefactive  changes 
in  the  intestine  which  the  presence  of  the  bacteria  of 
putrefaction  would  otherwise  bring  about. 

Throughout  the  whole  of  the  intestinal  canal,  from 
the  duodenum  to  the  termination  of  the  large  intes- 
tine, the  contents  continue  to  present  an  alkaline 
reaction,  and  the  action  of  the  pancreatic  ferments 
is  maintained.  Besides  the  bile  and  pancreatic  juice, 
the  food  when  it  reaches  the  small  intestine  encounters 
also  the  so-called  "  succus  entericus,"  or  intestinal 
juice,  secreted  by  the  glands  that  ai'e  found  embedded 
in  the  intestinal  mucous  membrane.  These  are  mainly 
Brunner's  glands  which  are  confined  to  the  upper  part 
of  the  small  intestine,  and  Lieberkiihn's  follicles, 
which  are  closely  packed  throughout  the  whole  length 
of  the  small  and  large  intestine. 

Since  in  the  small  intestine  the  food  encounters 
simultaneously   so   many   digestive   secretions,    it   is 


*  Mayo  Eobson  infers  from  the  results  of  his  observations  in  the 
case  of  biliary  fistula  that  "increase  of  body  weight  and  good 
health  are  quite  compatible  with  the  entire  absence  of  bile  from 
the  intestines,"  that  its  "antiseptic  properties  are  unimportant," 
and  that  it  is  "probably  chiefly  excrementitious. " —  On  G^ 
Stones,"  p.  32. 


Chap.  VI.]  Absorption  op  Food.  i  47 

almost  impossible  to  limit  accurately  the  particular 
part  that  each  one  plays  in  the  processes  of  digestion. 
Experiments  made  out  of  the  body  cannot  be  arranged 
under  precisely  the  same  conditions  as  those  which 
obtain  within  the  alimentary  canal,  and  conclusions 
drawn  exclusively  from  such  observation  are  exposed 
to  obvious  sources  of  error. 

The  succus  entericus  is  said  to  be  able  to  convert 
maltose  into  grape-sugar,  and  so  to  continue  the 
diastasic  action  of  the  saliva  and  pancreatic  juice ;  it 
is  also  believed  to  be  able  slowly  to  peptonise  fibrin. 
It  is  probable  that  portions  of  the  food  may  continue 
to  be  dissolved  in  the  lower  half  of  the  small  intes- 
tine under  the  influence  of  the  various  digestive  fer- 
ments that  have  been  mixed  with  it.  In  the  large 
intestine  the  digestive  processes  cease,  and  putrefactive 
changes  alone  continue ;  the  absorption  of  fluid,  how- 
ever, goes  on  so  that  the  contents  of  the  large  intestine 
increase  in  consistency  as  they  advance  along  it. 

The  food  has  now  been  traced  from  its  entrance 
into  the  mouth  to  its  complete  digestion  in  the  sniall 
intestine  ;  here  the  dissolved  food  substances  pass  into 
the  blood-vessels  and  lymphatics,  and  so  enter  the 
general  circulation.  The  peptones  immediately  on 
entering  the  blood-vessels  appear  to  undergo  certai)i 
changes.  They  are  taken  up,  to  a  great  extent,  by  the 
red  blood-corpuscles,  and  by  a  process  of  dehydration 
are  converted  back  again,  so  to  speak,  into  a  largiT 
and  more  complex  albuminous  molecule,  that  of 
ylohidin.  "  The  blood  corpuscles  thus  form,  as  it 
were,  a  stoi'e  of  albuminous  material,  which  they 
convey  to  all  parts  of  the  body,  and  give  off  where 
it  is  wanted."  A  portion,  however,  of  the  peptones 
appear  to  have  another  destination  _;  they  are  con- 
verted in  the  liver,  where  they  are  arrested,  into 
glycogen.  In  the  liver  also  the  sugar  absuibed  from 
the  intestinal  canal  is  dehydrated  and  converted 
likewise  into  glycogen.  There  it  is  stored  up  for  a 
time,  and  given  out  as  required  by  the  organism. 
K  2 


148  Food  in  Health.  [Parti. 

The  liver,  therefore,  is  a  great  storehouse  of  carbo- 
hydrates, and  it  serves  them  out  to  the  economy 
as  they  are  required. 

The  chief  amount  of  tlie  fats  is  absorbed  in  the 
form  of  a  inilk-like  emulsion,  and  a  small  portion,  in 
the  form  of  soluble  fat- soaps.  The  fats  themselves  are 
not  chemically  changed,  but  remain  as  undecomposed 
neutral  fats.  The  villi  of  the  small  intestine  are  the 
chief  organs  concerned  in  the  absorption  of  the  fattv 
emulsion,  and  in  these  the  lacteal  vessels  originate 
which  convey  the  chyle,  containing  the  fatty  granules, 
towards  the  thoracic  duct  on  its  way  to  join  the 
general  circulation. 

Sir  \V.  Roberts's  observations  led  him  to  the 
conclusion  that  the  effects  of  food-accessories  (for 
reasons  he  sets  forth)  on  pancreatic  digestion  are 
practically  nil.  "  lu  no  case  did  I  find  evidence  of 
the  possibility  of  that  embarrassment  and  arrest  which 
occurred  in  the  case  of  salivary  and  peptic  digestion."* 

The  usefulness  of  Aarious  articles  of  diet  in  nutri- 
tion must  depend  upon  their  diyeslibility  and  upon 
the  proportion  in  which  they  can  be  and  are  dissolved 
and  absorbed  in  the  alimentary  canal.  The  real 
nutritive  value,  therefore,  of  any  food  stuff  cannot  be 
accurately  determined  simply  by  reference  to  its 
chemical  composition,  but  can  only  be  properly 
estimated  by  actual  obser\ation  as  to  the  extent  to 
which  it  is  appropriated  by  the  organism.  It  nnist, 
at  the  same  time,  be  remembered  that  there  are  limits 
to  the  digestive  and  absor[)tive  capacities  of  the 
alimeiitary  canal,  which  vary  with  regard  to  different 
forms  of  food,  and  that  any  overloading  of  the 
digestive  organs  with  food-substances  it  cannot  com- 
pletely digest  is  most  injurious. 

In  the  case  of  a  complex  feeder  like  man  it  is 
undoubtedly  extremely  difficult  to  ascertain  to  what 
precise  extent  any  particular  component  of  his  diet  is 
utilisable  j  a  certain  amount  of  approximately  accurate 
information  can,  however,  be  obtained  in  various 
*    '  Dietetics  and  Dy8pei>sia."' 


Chap.  VI. 


Utilisation  of  Foods. 


149 


ways  which  will  afford  considerable  assistance  in  the 
solution  of  these  questions. 

It  is  well  known  how  much  the  digestibility  and 
full  utilisation  of  the  food  of  man  depend  on  its 
being  presented  to  him  in  sufficient  variety,  and  that 
a  monotonous  sameness  of  dietary  ends  by  becoming 
repulsive,  and  leads  to  actual  derangement  of  the 
digestive  organs.  Particular  methods  of  preparing 
and  cooking  food  also  greatly  determine  the  extent  of 
its  utilisation.  Individual  peculiarities,  habits,  and 
various  external  circumstances,  such  as  different 
climatic  conditions,  also  influence  the  digestion  and 
assimilation  of  different  articles  of  diet. 

One  of  the  most  marked  and  most  notable  differences 
in  the  utilisation  by  man  of  habitual  food-substances  is 
that  which  is  observed  between  animal  and  vegetable 
foods.  The  human  digestive  organs  can  assimilate 
vegetable  foods  far  less  completely  than  animal  foods. 
The  seeds  of  certain  cereals  when  submitted  to  a 
special  mode  of  preparation  and  cooking  form  the 
only  exception  to  this  rule. 

This  difference  in  the  power  of  utilising  animal 
and  vegetable  foods  is  well  illustrated  in  the  following 
table  of  Fr.  Hofmann  quoted  by  Bauer.  It  gives  the 
percentage  proportions  digested  and  undigested  of 
several  animal  and  vegetable  alimentary  substances  : — 


Vegetable. 

Animal. 

Weight  »f  FockI. 

Digested. 

Un- 
digested. 

Digested. 

Un- 
digested. 

Of  100  parts  of  Solids... 
MM       ^»      M  Albumen 
„     „       „      „      Carho-  \ 
hydrates         

75-5 
46-6 

90-3 

24-5 
.53-4 

9-7 

86-9 
81-2 

96-9 

131 
18-8 

3-1 

The  reason  of  the  great  amount  of  waste  which 


150  Food  in  Health,  [Pani. 

passes  out  of  the  body  undigested  in  the  case  of  many 
vegetable  foods  must  not  be  looked  for  in  any  great 
loss  of  unassimilated  starch  ;  for  large  quantities  of 
stai'ch  are  wholly  digested  and  absorbed  in  the  human 
alimentary  canal,  if  they  ai-e  contained  in  foods,  which 
in  other  respects  favour  the  action  of  the  digestive 
juices  upon  them.  It  has  been  found,  for  instance, 
that  the  carbohydrates  in  wheaten  bread,  in  mac- 
aroni, in  rice,  etc.,  are  utilised  to  within  0'8  to  1*6 
per  cent. ;  whereas  as  much  as  8  to  18  per  cent,  of 
undigested  residue  passes  out  of  the  body  from  such 
foods  as  black  bread,  potatoes,  and  the  like.  Some 
of  these  latter  set  up  acid  fermentations  in  the 
alimentary  canal,  which  excite  active  peristalsis  in  its 
walls  and  rapid  expulsion  of  its  contents.  In  many 
of  the  imperfectly  digested  vegetable  foods  the  nutritive 
matters  are  enclosed  in  cell-walls  of  indigestible, 
or  imperfectly,  or  very  slowly  digestible  cellulose, 
and  they  are  passed  through  the  intestinal  canal 
too  rapidly  for  the  digestive  juices  to  penetrate 
them.  Moreover,  hard,  ligneous  substances,  such  as 
the  bran  of  black  and  brown  bread,  provoke,  by 
mechanical  irritation,  active  intestinal  peristalsis. 
Indeed,  it  has  been  noticed  that  the  addition  of 
cellulose  to  a  meat  diet  will  cause  an  imperfect 
assimilation  even  of  the  flesh.  It  must  also  be  noted 
that,  as  a  rule,  vegetable  foods  are,  relatively  to  their 
nutritive  value,  more  bulky  than  animal  kinds,  and, 
for  that  reason,  tend  to  the  evacuation  of  a  greater 
amount  of  undigested  residue,  a^  they  have  to  be 
ingested  in  greater  relative  quantity. 

With  respect  to  the  utilisation  of  different  animal 
and  vegetable  foods,  some  valuable  experiments  have 
been  made  by  Eubner  and  are  summarised  by  Bauer.* 
It  has  been  objected  to  these  experimental  observations 
that  they  were  made  with  excessively  l.irge  quantities 
of  food,  such  as  could  not  be  taken  liabitually  ;  but 
they  nevertheless  illustrate  what  they  were  intended 
to  illustrate,  and  that  is  the  relative  proportions  in 
•  "  Dietary  of  the  Sick." 


Chap.  Vl.l 


Utilisation  of  Foods. 


151 


which    the    several   articles   of  food   tested   can   be 
utilised  in  the  organism. 

It  has  long  been  well  known  that  the  flesh  of 
animals  can  be  utilised  to  a  remarkable  extent,  and 
Rubner  tested  this  fact  upon  himself  by  eating,  for 
three  consecutive  days,  large  quantities  of  roast  beef, 
with  the  following  results  : — 


Total  Amount  Ingested. 

Pekcentaoe  Lost  in  F;eces. 

Dry 
Matters. 

Nitrogen. 

Fat. 

Ash. 

45-7 
55-9 

Dry 

Jfatters. 

Nitro- 
gen. 

Fat. 

17-2 
21-1 

Ash. 

919 
1100 

119-5 
146-3 

71-9 
62-6 

5-6 
4-7 

2-8 
2-5 

21-2 
15-0 

Broken-down  muscular  fibres  could  be  detected  in 
the  evacuations,  which  is  not  the  case  when  smaller 
quantities  of  meat  are  taken  and  digestion  is  normal ; 
so  that,  under  the  latter  conditions,  certainly  a  large 
percentage  would  be  utilised. 

With  hard-boiled  eggs  the  following  results  were 
obtained  :  in  two  days,  1,896  grammes  of  fresh  eggs 
were  eaten,  representing  495  grammes  of  water  fre(! 
(dry)  food  substance,  and  containing  41-5  grammes  of 
nitrogen,  206-7  gramn  es  of  fat,  and  209  grammes  of 
ash.  The  percentage  loss  of  each  of  these  in  the 
faeces  was,  of 


Dry  Food  Substances     ... 

5-2  per  cent 

Nitrogen 

...         2-9  „       „ 

Fat            

5-0  „       „ 

Ash           

...       18-4  ,.       „ 

showing  that  a  very  large  percentage  was  utilised  in 
the  system. 

The  same  observer's  experiments  with  milk 
showed  a  very  extensive  utilisation  of  the  organic 
constituents,  although  not  so  extensive  as  with  the 
preceding  substances,  and  there  was  especially  a 
greater  loss  of  salts,  and  particularly  of  lime  salts. 


152 


Food  in  Health. 


I  Pan  I. 


It  was  also  found  that  milk  and  cheese  admin- 
istered together  were  well  assimilated. 

As  to  the  utilisation  of  vegetable  foods,  some  of 
the  most  important  series  of  experiments  refer  to  the 
assimilation  of  various  kinds  of  bread.  The  following 
table  gives  the  results  obtained  by  G.  Maj-er  : — 

Ingested. 


White  Wheaten  Bread    ... 

Dry  Sub- 
stances. 

Nitrogen. 

Asli. 

1. 

4  39 -.5 

8-8 

U)-r<r 

0 

Munich  Rye  Bread 

438-1 

10  5 

18-1 

3. 

Pumper  Nickel 

Loss  per  cent 

422-7 

9-4 

8-2 

1. 

White  Bread        

.V6 

19-9 

30-2 

2 

Rye  Bread 

10  1 

22-2 

.30-0 

3. 

Pumper  Nickel      

19-3 

42-3 

90-6 

In  these  and  Rubner's  experiments  the  important 
fact  is  established  that  the  finer  white  kinds  of  bread 
are  much  more  completely  utilised  in  the  organisms 
than  the  coarser  brown  or  l)lack  (rye)  kinds. 

Experiments  with  macaroni  gave  similar  results 
to  those  with  white  bread. 

Rice  and  maize  were  also  found  to  be  well 
i),ssimilated  by  the  human  digestive  organs. 

As  to  the  utilisation  of  the  leguminosse,  several 
experiments  have  been  made  by  various  observers  as 
to  the  nutritive  value  of  pea-s.  It  was  immediately 
noticed  that  the  mode  of  cooking  exerci.sed  a  great 
influence  on  the  digestibility.  When  pea-meal  was 
con.sumed  for  four  con.secutive  days,  jirepared  with 
milk,  butter,  and  eggs  ;  of  a  total  of  87.5  grammes  of 
dry  substance  ingested,  containing  36-9  grammes  of 
nitrogen,  only  8-2  per  cent,  of  this  nitrogen  was  lost 
in  the  faeces.  In  a  second  experiment  with  le7i'i!.s\ 
simplt/  soaked  in  water  and  hoi/^d,  40  2  per  cent,  of 
the  nitrogen  was  eliminated  unused.* 

■Woroschiloff,  Strumpell.     Rubner. 


Chap.  VI.  1 


Utilisation  qf  Foods. 


JS3 


Experiments  with  regard  to  the  utilisation  of 
potatoes,  carrots,  and  savoy  cabbages,  showed  that  it 
was  defective. 

Experiments  as  to  the  capacity  of  the  human 
organs  to  digest  cellulose  were  tested  with  celery, 
cabbage  and  carrots,  and  it  was  found  that  of  unlig- 
nified  cellulose  from  47*3  to  627  per  cent,  could  be 
digested. 

The  absorption  of  fat  in  the  human  organism  was 
also  tested  by  Rubner  in  a  series  of  experiments,  in 
which,  besides  bread  and  meat,  large  quantities  of  fat, 
bacon,  and  butter  were  administered.  The  following 
table?  give  the  results  obtained  when  variable  quanti- 
ties, from  100  grains  up  to  the  largest  amount  pos- 
sible were  consumed,  together  with  bread  anrl 
meat : — 

Ingested. 


Bacon,  100  gramme-s  daily 

.,      200         „ 
Batter,200         „ 
Greatest  possible  quantity  | 
of  Fat ) 


Dry 

Snb- 


1090 
1222 
1231 

1.562 


Nitro- 
gen. 


47-3 
471 
43-9 

46-7 


Cai-lK>- 
liydiiitfis. 


1980 
3894 
428-1 

701-0 


519-2 
432-8 
443-1 

468-7 


I'tiecntage  loss  in   Fteces 

Bacon,  100  gi-amnies 

„      200  

Biitter,200 

Greatest  possible  quantity 


8-5 

12-1 

17-4 

16 

9-2 

14-0 

7-8 

6-2 

6-7 

11-3 

2-7 

6-2 

10-5 

9-2 

12-2 

6-8  : 

47*0 
43-0 
51  0 

54  9 


28-5 
25-1 
20-0 
27-7 


Some  interesting  points  in  the  assimilation  of  fats 
may  be  noticed  in  the  results  of  the.se  experimt^nts. 
In  the  first  place  we  notice  that  the  whole  amount  of 
fat  passed  by  the  bowels  was  almost  the  same  when 
200  as  when  100  grammes  of  bacon  were  consumed, 
and  it  was  not  until  the  daily  consumption  of  fat 
exceeded    351    grammes    that   the   limit   of    perfect 


154  Fonn  in  Health.  [Parti. 

assimilation  was  surpassed.  From  this  it  may  be  con- 
cluded that  the  loss  of  fat  in  the  process  does  not  rise 
with  the  consumption  of  fat,  but  remains  the  same  until 
a  certain  maximum  is  exceeded,  and  after  that  the  pro- 
portion of  fat  assimilated  rapidly  declines.  It  is  also 
shown  that  the  utilisation  of  bacon  is  less  than  that 
of  butter,  a  circumstance  probably  accounted  for  by 
the  fact  that  in  the  latter  the  fat  is  not  enclosed  in 
cells.  The  utilisation  of  other  food  is  likewise  influ- 
enced by  these  large  quantities  of  fat,  for  that  of  the 
carbohydrates  was  less  complete  when  large  quantities, 
than  when  smaller  amounts  of  fat  were  taken. 

The  utilisation  and  digestibility  of  dift'erent  food- 
substances  are,  no  doubt,  greatly  influenced  by  patho- 
logical conditions,  as,  for  instance,  in  the  febrile  state, 
but  accurate  information  resting  on  an  experimental 
basis  is  much  needed  in  this  direction. 


;^ 


155  1''^ 


CHAPTER   YII. 

THE    COOKING,    PREPARATION,    AND    PRESERVATION    OF 
FOOD. 

Man  is  the  only  animal  that  cooks  his  food,  and  al- 
though it  is  possible  there  may  exist  certain  savage 
races  that  have  no  knowledge  of  cooking,  it  is  certain 
that  civilised  man  invariably  cooks  some  portions  of 
his  food,  and  it  would  seem  also  to  be  certain  that 
advances  in  civilisation  are  accompanied  by  propor- 
tionate progress  in  the  culinary  art. 

Cooking  answers  most  important  purposes  in  con- 
nection with  food.  In  the  first  place,  it  improves  oi* 
develops  agreeable  flavours  in  food,  especially  in 
animal  foods.  By  the  action  of  a  high  temperature 
on  meat,  and  the  flesh  of  animals  generally,  agree- 
able gustatory  properties  are  developed  which  they 
do  not  possess  in  the  uncooked  state,  and  they  are 
thus  rendered  capable  of  giving  pleasurable  excitement 
to  the  sense  of  taste.  Cooking  thus  increases  the 
desire  to  take  food.  In  the  next  place,  it  enables  the 
food  to  be  more  readUy  masticated,  and  more  easily 
digested.  The  mastication  of  animal  food  is  greatly 
facilitated  by  cooking,  for  in  the  raw  state  it  is  tough 
and  tenacious,  and  torn  apart  with  difficulty  ;  whereas 
after  cooking  the  muscular  fibres  become  more  solid 
and  firmer,  while  they  lose  much  of  their  toughness, 
and  are  far  more  readily  divided  or  tora  apart  by  the 
teeth,  while  the  fibrous  tissue  connecting  them  to- 
gether is  softened  and  gelatinised.  The  whole  mas.s 
is  thus  rendered  much  less  coherent  and  more  suscej*- 
tible  of  mechanical  subdivision.  The  lessened  cohesion 
and  increased  mechanical  divisibility  which  cooking 
imparts  to  food,  greatly  favour  its  digestibility,  by 


156  Food  in  Health.  [Pani. 

enabling  the  digestive  juices  to  come  into  intimate 
contact  with  it,  and  to  penetrate  readily  into  its  sub- 
stance. Cooking  thiis  leads  to  important  mechanical 
and  chemical  changes  in  food,  which  greatly  facili- 
tate its  digestion. 

The  exposure  of  food  to  a  high  temperature  affords 
the  further  safeguard  of  destroying  parasitic  or  other 
miniite  living  creatures  or  germs  which  may  acci- 
dentally be  present  in  it.  The  effect  of  a  certain  degree 
of  heat  on  animal  flesh  is  that  the  albumen  is  coagu- 
lated, and  the  fibrous  connective  tissues  are  converted 
into  gelatin.  Nor  is  the  warmth  that  cooking  imparts 
to  food  a  matter  of  indifference,  for  in  many  instances 
it  promotes  the  digestive  action  of  the  .stomach  upon 
it,  and  increases  its  stimulating  effects. 

Boiling:. — One  of  the  simplest  and  most  con- 
venient modes  of  cooking  animal  food  is  that  of  boiling. 
One  of  the  first  effects  of  plunging  meat  into  water  is 
that  some  of  the  soluble  constituents  of  the  meat  pass 
out  into  the  water,  a  portion  of  the  soluble  albumen, 
of  the  extractives,  and  of  the  salts.  To  what  extent 
these  soluble  constituents  shall  be  extracted  by  the 
water,  or  be  retained  in  the  meat,  will  depend  on  the 
manner  in  which  the  process  of  boiling  is  carried  out. 
In  prolonged  boiling  more  or  less  of  the  connective 
tissue  is  converted  into  gelatin,  and  is  dissolved  in 
the  water ;  some  of  the  fat,  of  course,  melts  at  this 
high  temperature  and  floats  on  the  surface.  The 
water  in  which  the  meat  is  boiled  is  termed  broth,  or 
in  French  homRon.  When  the  object  is  to  retain 
as  much  as  possible  of  the  soluble  constitur^nts  in  the 
meat,  the  process  of  boiling  must  be  conducted 
differently  from  what  it  is  when  the  contraiy  is  de.sired, 
viz.  to  extract  as  much  as  possible  of  the  nutritive 
constituents  of  the  meat  in  the  broth.  In  the  first 
case,  the  meat,  which  should  be  in  one  lai'ge  piece,  is 
plunged  into  the  water  which  is  already  hoiling,  and 
it  is  then  kept  on  the  boil  for  about  five  minutes.  By 
this  means  the  albuminous  matter  in  the  external 
layers  of  the  joint  is  rapidly  coagulated^  so  as  to  form 


Chap.  VII.]  Methods  of  Boiling.  157 

a  protective  layer  on  its  surface  ;  this  retains  the  juices 
and  soluble  constituents  in  the  interior  of  the  meat, 
and  prevents  their  escape  into  the  water.  The  meat 
is  thus  kept  juicy  and  palatable  throughout  its  interior, 
and  the  broth  is  thin  and  poor.  After  boiling  briskly 
for  five  minutes,  the  cooking  should  be  completed  at  a 
temperature  of  160"  to  170°  F.  If  a  lower  tempera 
ture  than  this  be  employed,  the  albuminous  matter  in 
the  interior  will  not  be  properly  coagulated,  and  the  joint 
will  cut  with  a  raw  and  uncooked  appearance  ;  and  if 
this  temperature  be  much  exceeded,  the  muscular  fibre 
tends  to  shrink  and  become  hard  and  indigestible. 
Many  cooks  employ  too  great  heat  in  boiling,  and  so 
cause  the  meat  to  be  hard  and  shrunken.  Liebig  re- 
commended a  temperature  of  158"  to  160°  F.,  and 
Parkes  says  after  the  first  five  minutes  of  boiling  "  the 
heat  can  scarcely  be  too  low,"  and  he  points  out  that 
the  *•  tempemture  of  coagulation  of  the  albuminous 
substances  difl'ers  in  the  different  constituents  ;  one 
kind  of  albumen  coagulates  at  as  low  a  heat  as  86°  F., 
if  the  muscle  serum  be  very  acid ;  another  albumen 
coagulates  at  113^  F. ;  a  large  quantity  of  albumen 
coagulates  at  167°.  The  hajmato-globulin  coagulates 
at  158°  to  162°,  below  which  temperature  the  meat 
will  be  underdone.  In  boiling,  ammonium  sulphide  is 
evolved  with  odoriferous  conqtounds,  and  an  acid  like 
acetic  acid." 

If,  on  the  other  hand,  the  object  is  to  make  a  rich 
and  nutritious  broth,  and  therefore  to  extract  as  much 
as  possible  of  the  soluble  constituents  of  the  meat  into 
the  water,  a  different  method  is  followed.  The  meat, 
cut  into  small  pieces,  is  put  into  cold  water,  and  the 
tem|)ei"ature  should  then  be  gradually  raised  to  about 
150°  or  160°.  Actual  boiling  should  be  avoided  in 
making  strong  broth,  in  order  to  avoid  the  coagulation 
and  precipitation  of  the  albiunen.  But  in  the  pre- 
paration of  soups,  prolonged  boiling  is  needed  in  order 
fully  to  extract  the  gelatin.  It  is  the  gelatin,  in- 
deed, which  forms  the  basis  of  soups,  for  the  coagulated 
albumen  floating  in  the  fluid  is  usually  removed  by 


158  Food  jn  Health.  [Parti. 

straining.  Boiled  in  this  manner  the  nutritive  prin- 
ciples of  the  meat  pass  out  as  completely  as  possiVjle 
into  the  water  in  which  it  is  cooked,  and  impart  to  it 
the  flavour  and  much  of  the  nutritive  qualities  of  the 
meat,  while  only  a  tough,  tasteless,  stringy  solid  residue 
is  left.  We  thus  see  that  either  the  joint  must  be 
sacrificed  to  the  broth,  or  the  broth  must  be  sacrificed 
to  the  joint.  Of  course,  inferior  parts  of  meat,  and 
bones,  may  be  largely  utilised  when  our  object  is  simply 
to  make  strong  broth  or  soup. 

Parkes  states  that  beef  gives  the  weakest  broth, 
containing  in  a  pint  about  150  grains  of  organic 
matter  and  90  grains  of  salts.  Mutton  broth  is  a 
little  stronger,  and  chicken  broth  strongest  of  all. 
About  82  per  cent,  of  the  salts  of  beef  pass  into  the 
broth,  i.e.  all  the  chlorides  and  most  of  the  phos- 
phates. Broth  can  also  be  made  without  the  appli- 
cation of  heat  by  digesting  half  a  pound  of  finely- 
minced  beef  with  a  pint  of  water,  to  which  four  drops 
of  hydrochloric  acid  have  been  added.  This  is  richer 
in  soluble  albumen  than  when  heat  is  employed.  By 
using  rather  mox'e  hydrochloric  acid,  but  no  salt,  heat 
can  be  applied  up  to  130°  F.,  and  by  this  method 
nearly  50  per  cent,  of  the  meat  can  be  obtained  in 
the  broth. 

The  efiect,  then,  of  boiling  on  the  joint  (cooked 
for  its  own  sake,  and  not  for  the  broth)  is  to  coagu- 
late the  albumen,  to  loosen  the  muscular  fibres,  and 
to  absti'act  a  portion  of  the  water  and  .some  of  the 
soluble  extractives.  There  is,  therefore,  a  con- 
siderable loss  of  weight  in  the  process  of  boiling, 
variously  estimated  at  from  20  to  30  and  even  40 
per  cent. 

The  clear  broth,  after  skimming  from  it  the 
melted  fat,  together  with  the  coagulated  albumen 
which  collects  on  the  surface  with  the  fat,  contains 
very  little  nutritive  substance.  It  contains  the  salts 
of  flesh,  some  gelatin  and  soluble  extractives,  and 
forms  a  fluid  stimulating  to  the  digestive  organs, 
although  not,  perhaps,  directly  nutritious.     According 


Chap.  VII.]         Methods  of  Roasting.  159 

to  Bauer,  500  gramines  of  meat  will  suffice  to  prepare 
a  litre  of  strong  broth,  which  should  be  flavoured 
with  a  few  aromatic  vegetables. 
-  Roasting;. — This  method  of  cooking  retains  the 
/'  nutritive  juices  and  the  extractives  more  completely 
than  boiling.  In  order  to  retain  the  juices  as  much 
as  possible,  the  joint  should  be  at  first  exposed  to  a 
strong  heat,  and  afterwards  cooked  very  slowly.  By 
this  method  the  surface  layers  are  at  once  coagulated, 
water  is  evaporated,  and  a  sort  of  crust  is  formed, 
which  presents  a  barrier  to  the  subsequent  escape  of 
the  juices  of  the  meat.  The  joint  is  removed  to  a 
greater  distance  from  the  fire,  and  the  lower  tempera- 
ture is  allowed  to  penetrate  slowly  to  the  interior. 
By  this  means  the  albumen  and  the  coloured  juices 
of  the  flesh  are  slowly  coagulated  without  any  great 
shrinking  and  hardening  of  the  muscular  fibre.  A 
certain  amount  of  the  meat  juice,  however,  escapes 
during  roasting,  and  this,  together  with  the  melted 
fat,  foi-ms  the  "  gravy,"  to  which  some  gelatin  be- 
comes added  when  the  high  temperature  is  long 
maintained.  Continual  basting  with  the  melted  fat 
is  an  important  part  of  the  process,  as  it  tends  to 
difiuse  the  heat  uniformly  over  the  joint  and  to  pre- 
vent scoi'ching  and  too  great  hardening  of  the  surface. 
As  the  surface  becomes  browned  by  the  influence 
of  a  higher  temperature,  several  new  odorous  and 
sapid  substances  are  developed,  which  give  to  roast 
meat  its  characteristic  odour  and  taste.  If  too  strong 
a  heat  is  employed,  the  fat  is  apt  to  undergo  de- 
composition, and  fatty  acids  are  (levelojjed,  attended 
with  the  disengagement  of  volatile  products  having 
a  most  penetrating  and  disagreeable  odour,  and  often 
proving  irritating  to  the  digestive  oi-gans.  If  the  tem- 
perature of  the  interior  of  the  joint  does  not  rise 
above  130°  F.,  it  remains  reddish,  blood-tinged,  and 
"underdone."  For  beef,  mutton,  and  game  this 
temperature  is  sufficient,  and  gives  the  tenderest 
meat  and  the  best-flavoured  ;  but  for  veal  and  poultry 
a  higher  temperature — 158°  to  160°  F. — is  needed. 


i6o  •  -  l^ooD  IN  Health.  [Parti. 

The  colouring-matter  of  the  blood,  as  we  have  seen, 
coagulates  at  this  point.  If  the  temperature  is 
allowed  to  exceed  this,  the  muscular  fibre  becomes 
hard  and  tasteless.  In  roasting  small  joints,  in  order 
to  keep  them  juicy  and  sa\oury  and  "  underdone  " 
throughout,  they  must  be  i)iit  for  a  short  time  in 
very  hot  fat,  as  in  cooking  steaks ;  so,  also,  in  order 
to  avoid  the  formation  of  a  hard,  dry  crust  on  lean 
meat,  it  should  be  freely  basted  with  added  fat. 
The  loss  of  weight  in  roasting  is  due  chiefly  to  loss 
of  water,  and  is  estimated  variously  by  difierent 
writers.  Bauer  puts  it  at  a  much  lower  percentage 
than  that  by  boiling,  viz.  20  to  24  per  cent. ;  Parkes 
gives  20  to  35  per  cent. — about  the  same  as  in  boil- 
ing ;  but  probably  much  depends  on  the  inethod  of 
roasting. 

The  loss  in  baking  is  said  to  be  rather  less. 

In  other  methods  of  cooking  meat,  the  changes  it 
undergoes  are  essentially  the  same  as  in  boiling  and 
roasting.     One  of  the  most  popular  is 

Slewiiijf.-  In  this  process  the  meat  is  usually 
cut  up  into  small  or  moderately-sized  portions,  and 
placed  in  just  enough  water  to  cover  it.  It  is  then 
allowed  to  simmer  gently  for  a  considerable  time. 
The  meat  should  be  cooked  slowly  ;  and  the  water 
should  not  be  allowed  to  boil,  for  if  boiling  occur, 
the  meat  will  become  tough  and  hard.  Much  of  the 
nutritive  matters  of  the  meat  passes  out  into  the 
surrounding  liquid,  which  becomes  thick,  rich,  and 
grea.sy,  to  which  sliced  vegetables  and  other  flavour- 
ing ingredients  are  usually  added.  When  properly 
stesved,  tl^e  texture  of  the  meat  becomes  greatly 
loosened,  so  that  it  breaks  down  readily  under 
pressure,  and  should  be  thus  re^jdered  easy  of  diges- 
tion ;  but  the  other  substances  and  the  sauces  so 
frequently  added  to  stews  often  interfere  greatly 
with  their  digestibility ;  and  it  is  probable  that 
when,  as  is  not  uncommon,  the  stewed  substances 
are  kei»t  for  a  veiy  long  time  at  a  high  temperature, 
toxic  [iroducts  may  be  developed  by  decomposition  of 


Chap.  VII.)  Braising.  ^  i6i 

some  of  the  albuminates.  Stewing  is  an  economical 
method  of  cooking  meat,  as  the  loss  is  much  less  than 
in  boiling  or  roasting,  viz.  about  20  per  cent.,  and  is 
chiefly  due  to  the  water  evaporated.  The  whole  of 
the  stew  is  eaten — meat,  vegetables,  and  gravy — so 
that  there  is  no  loss  of  nutritive  constituents.  When 
this  process  is  applied  to  previously- cooked  meat  it  is 
termed  a  "  hash."  In  this  the  meat  is  often  hard, 
dry  and  tasteless. 

Braising. — Sir  Henry  Thompson  has  called  at- 
tention to  the  neglect  in  England  of  the  method 
of  '*  braising  "  in  cooking.  He  refei"s  to  it  as  a 
valuable  process  in  the  preparation  of  animal  food, 
and  as  "  sn]>erior  in  some  respects  to  that  which  the 
term  '  stewing '  denotes.  In  braising,  the  meat  is 
just  covered  with  a  strong  liquor  of  vegetable  and 
animal  juices  (technically  called  braise  or  mirepoix)  in 
a  closely  covered  vessel,  from  which  as  little  evapora- 
tion as  possible  is  permitted,  and  is  exposed  for  a 
considerable  time  to  a  surrounding  heat  just  short  of 
boiling.  By  this  treatment  tough,  fibrous  flesh,  even 
if  old,  whether  of  poultry,  of  cattle,  or  meat  unduly 
fresh,  such  as  it  is  difficult  to  avoid  during  the  sum- 
mer heats  in  town,  is  made  tender  and  easily  digestible. 
Moreover,  it  becomes  impregnated  with  the  odour  and 
flavour  of  fresh  vegetables  and  sweet  herbs,  while  the 
liquor  itself,  slowly  reduced  in  the  process,  furnishes 
the  most  appropriate,  fragrant,  and  delicious  sauce 
with  which  to  surround  the  portion  when  served  at 
table.  Thus  also  meats  which  are  dry,  or  with  little 
natural  flavour,  as  veal,  become  saturated  with  juices, 
and  combined  with  sapid  substances,  which  render  the 
food  succulent  and  delicious  to  the  palate.  Small 
portions  sufficing  for  a  single  meal,  however  small  the 
family,  can  be  thus  dealt  with.  .  .  The  first  principle 
essential  to  a  braise  is  that  the  meat  so  to  be  treated 
must  be  very  slowly  cooked  in  a  closely  covered  vessel, 
and  with  a  small  quantity  of  liquid.  The  second 
principle  is  that  the  meat  shall  be  impregnated  in 
this  process  with  the  flavour  of  vegetables,  herbs,  etc., 


1 62  Food  in  Health.  [Pani. 

and  of  some  spices  and,  if  desired,  with  wine.  This 
is  to  be  done  by  placiiig  in  the  braise-pot  around  the 
meat  shces  of  ham  or  bacon,  cut  carrots,  parsnips, 
turnips,  onions,  various  herbs,  a  bay-leaf,  cloves,  and 
other  spices,  and  a  little  wine  ;  together  with  a  small 
quantity  of  good  meat  stock.  .  .  The  third  principle 
is  not  generally  considered  absolutely  essential  to  the 
process,  although  it  is  undoubtedly  the  last  refinement 
necessary  to  produce  a  first-rate  braise.  It  is  that  of 
partially  browning  or  half  roasting  the  portion  also, 
and  this  may  be  accomplished  in  two  ways.  The 
legitimate  or  original  way  of  doing  this  is  to  have 
weil-titted  to  the  braise-pot  a  sunk  copper  or  iron 
cover,  in  which  some  hot  coals  or  charcoal  are  placed, 
in  order  to  transmit  downwards  a  scorching  heat  to 
the  top  of  the  portion  which  is  uncovered  by  the 
liquid  in  the  pot  below.  In  this  case  it  is  usual  to 
cover  the  portions,  especially  of  a  fowl,  with  a  piece 
of  white  paper,  which  serves  to  shield  a  delicate 
morsel  from  a  too  fierce  heat.  The  other  and  inferior 
way  is  very  lightly  to  roast  the  meat  before  putting 
it  into  the  pot  to  braise,  and  so  dispense  with  th 
coals  on  the  cover  ;  but  this  hardens  it  and  prevent 
the  juices  from  penetrating."  * 

Broiling  or  ^i-iliing  is  the  same  as  roasting, 
only  it  is  applied  to  smaller  portions  of  meat,  and  is 
therefore  a  much  more  rai)id  process,  and  a  far  larger 
surface  is  exposed  to  the  direct  action  of  a  high 
temperature.  In  order  to  preserve  the  juices  within 
the  meat  the  same  principle  must  be  applied  as  in 
roasting.  It  is  a  method  which  develops  the  flavour 
of  the  meat  very  completely,  and  has  the  further 
advantage  of  being  rapid  and  convenient. 

The  flavour  of  baked  meat  is  inferior  to  that  of 
meat  roasted  before  an  open  fire,  for  when  cooked  at 
a  high  temperature  in  a  confined  space,  the  volatile 
fatty  acids  generated  in  the  process  are  unable  to 
escape,  and  they  are  therefore  retained  in  contact  with 
the  joint,  which  acquires  a  rich,  strong  flavour,  and  is 
•  "  FockI  and  Feeding." 


Chap.  VII.]  ERYING,  163 

imsuited  for  the  consumption  of  persons  of  delicate 
digestions. 

Frying  is  also  a  mode  of  cooking  meat  ill  suited 
for«the  purpose  of  increasing  its  digestibility.  Usually 
the  meat,  cut  into  thin  slices,  is  put  into  boiling  oil 
or  fat  with  which  it  becomes  more  or  less  saturated, 
and  is  thus  rendered  somewhat  impermeable  to  the 
digestive  juices.  Fatty  acids,  developed  during  the 
action  of  a  high  temperature  on  the  fat,  are  also 
apt  to  remain  in  contact  with  the  meat,  and  to  lead  to 
disturbance  of  the  digestive  process,  attended  with  the 
formation  of  irritating  acid  substances  in  the  stomach.* 

Whatever  method  of  cooking  meat  be  adopted,  one 
gi'eat  rule  should  always  be  attended  to,  viz.  to  cook 
the  meat  slowly  and  with  as  little  heat  as  possible, 
so  that  the  loss  may  be  chiefly  due  to  the  water 
evaporated.t  Too  great  heat  is  commonly  employed 
in  cooking  on  a  large  scale,  and  the  meat,  instead  of 
being  juicy  and  full  of  flavour,  is  often  sodden  and 
tasteless,  and  the  muscular  fibres  are  hard,  shrunken, 
and  indigestible. 


*  Some  critical  remarks  on  the  process  of  frjring,  by  Sir  Henry 
Thompson,  may  be  studied  with  advantage.  "The  art  of  frying," 
he  says,  "is  little  understood,  and  the  omelette  is  almost 
entirely  neglected  by  our  countrymen.  The  products  of  our 
frying-pan  are  often  greasy,  and  therefore  for  many  persons 
indigestible,  the  shallow  form  of  the  pan  being  unsuited  for 
the  process  of  boiling  in  oil — that  is,  at  a  heat  of  nearly  500°  F. 
This  high  temperature  produces  results  which  are  equivalent  indeed 
to  quick  roasting,  when  the  article  to  be  cooked  is  immersed  in 
the  boiling  fat.  Frying,  as  generally  conducted,  is  rather  a  com- 
bination of  broiling  and  toasting  or  scorching  ;  and  the  use  of  the 
deep  pan  of  boiling  oil  or  dripping,  which  is  essential  to  the  right 
performance  of  the  process,  and  especially  preventing  greasine-s, 
is  a  rare  exception  and  not  the  rule  in  ordinary  kitchens.  The 
principle  on  which  success  depends  is,  that  at  the  moment  of  con- 
tact with  the  almost  boiling  oil,  a  thin  film  of  every  part  of  the 
surface  of  the  fish  or  other  object  to  be  fried  is  coagulated,  so  that 
the  juices  with  their  flavours,  etc.,  are  at  once  locked  up  within, 
and  no  quality  can  escape.  The  bath  of  oil  should  therefore  be  in 
quantity  sufficient,  and  also  be  hot  enough  to  effect  this  result  in  an 
instant;  after  which,  and  during  the  few  minutes  requisite  to  cook 
the  interior,  the  heat  is  often  slightly  lowered  with  advantage." 

t  Parkes  states  that  the  loss  to  the  soldier  from  cutting  up, 
from  bone  and  from  cooking,  amounts  to  C  or  7  out  of  12  oz. 

l2 


164  Food  in  Health.  [Pani. 

In  cooking  salt  meat,  which  is  invariably  boiled, 
the  heat  should  be  aj)plied  very  slowly  and  for  a  long 
time ;  the  addition  of  a  little  vinegar  is  said  to  have  a 
useful  softening  effect. 

Fish  is  cooked  for  the  same  purpose  as  meat,  and 
is  usually  either  boiled,  grilled,  or  fried.  It  is  most 
easily  digested  when  boiled;  the  next  best  method  is 
grilling.  Fish  requires  to  be  tliorouyhbj  boiled,  so 
that  it  can  readily  be  detached  from  the  bones ;  but 
it  requires  a  shorter  time  than  meat.  The  harder  the 
water  in  which  it  is  boiled  the  firmer  is  the  flesh  of 
the  fish.  Fish  boiled  in  soa-water,  or  in  water  to 
which  salt  has  been  added,  is  firmer  and  of  finer 
flavour  than  when  boiled  in  soft  water,  because  of  the 
solvent  effect  of  the  latter. 

Fish  fried  in  fat  is  not  a  suitable  food  for  persons 
of  delicate  digestion. 

The  preparation  and  nutritive  value  of  soups, 
broths,  and  the  various  meat  extracts,  will  be  more 
conveniently  considered  hereafter. 

The  Cooking  of  Vegetable  Foods  must  next  be 
considered.  Many  vegetable  substances  used  for  food 
by  man  are  absolutely  inedible  in  the  raw,  unprepared 
condition,  while  others  are  rendered  more  palatable 
and  digestible  by  cooking  processes.  Mechanical  sub- 
division and  the  action  of  a  high  temperature  are  the 
chief  processes  applied  to  the  preparation  of  vegetable 
foods.  By  these  processes  the  vegetable  structures  are 
softened  and  the  intercellular  substance  is  loosened, 
so  that  they  are  more  readily  fimenable  to  the  pro- 
cesses of  mastication ;  by  ruptiHre  of  the  cell  walls, 
the  nutritive  cell  contents  are  set  free,  while  by  the 
action  of  heat  on  the  starch  granules,  the  principal 
alimentary  constituent  in  vegetable  tissues,  important 
physical  changes  occur  which  greatly  aid  the  digestion 
of  starch.  Heat  causes  the  starch  granule  to  swell 
up,  its  outer  envelope  is  ruptured,  and  its  contents 
are  set  free,  so  that  they  can  be  readily  acted  on  by 
the  digestive  secretions.     Unless  submitted   to   this 


Chap.  VII.]  BkEAD-MaKING.  1 65 

influence,  the  outer  envelope  of  the  starch  granule  offers 
great  resistance  to  the  action  of  the  digestive  juices 
on  its  contents.  Besides  this  action  on  the  starch 
granules,  cooking,  as  in  the  case  of  animal  food, 
coagulates  any  soluble  albuminous  substances  in  the 
vegetable  tissuesor  juices  ;  and  in  boiling,  the  soluble, 
gummy,  saccharine,  colouring  and  saline  matters  are, 
of  course,  to  a  great  extent  extracted  in  the  water. 

Undoubtedly,  Bread-making  is  one  of  the  most 
important  cooking  processes  that  are  applied  to  the 
preparation  of  human  food,  and  it  is  practised  amongst 
all  civilised  nations. 

The  art  of  bread-making  consists  in  converting 
flour  or  meal  into  a  firm  and  porous  substance,  whiclj 
can  be  readily  masticated,  and  which,  while  it  retains 
a  certain  amount  of  water,,  is  not  noticeably  moist  or 
sticky. 

The  first  step  in  this  'process  is  the  formation  of 
a  dough  or  paste  by  mixing  the  flour  with  a  certain 
quantity  of  water  and  kneading  this  together  by  the 
hands  or  by  machinery.  The  next  step  is  to  impart 
the  necessary  property  of  porosity  by  intimately 
mixing  carbonic  acid  with  the  dough,  either  by 
generating  it  within  its  substance,  or  forcing  it  in 
from  without. 

The  first  of  these  methods  may  be  effected  either 
by  fernjentation  or  by  the  use  of  so-called  "baking 
powders " ;  and  the  second  by  Dauglish's  process  for 
forcing  carbonic  acid  into  the  dough  by  pressure. 
Owing  to  the  tenacity  of  the  gluten  of  the  meal,  the 
vesicles  of  gas  are  held  together,  and  a  light,  spongy 
mass  is  formed.  It  is  then  exposed,  in  suitable 
portions,  to  the"  heat  of  the  oven,  and  by  the  proce.-ss 
of  baking  it  is  solidified  and  converted  into  a  fii-m  and 
permanently  porous  bread. 

Leavened  bread  is  the  term  applied  to  bread  in 
which  the  carbonic  acid  has  been  generated  by  ^er- 
mentntion.  The  ferment  used  is  either  yeast  or 
leaven,  that  is,  old  dough  in  a  state  of  fermentation. 
The  yeast  fungus,  Torula  or  baccJiarumi/cetes  cerevtsice, 


i66  Food  in  Health.  [Parti. 

is  tlie  active  ap;ent  in  either  case.  This  converts  the 
sugar  in  the  dougli  into  alcohol  and  carbonic  acid. 
It  is  usual  in  making  bread  by  fermentation  to  mix  a 
certain  quantity  of  the  flour  with  the  ferment,  some 
salt,  and  lukewarm  water.  These  are  kneaded  into  a 
stiff  paste  or  dough,  which  is  placed  aside  in  a  warm 
situation  for  an  hour  or  two.  The  mass  gradually 
swells  up,  from  the  evolution  of  carbonic  acid  gas, 
or,  as  the  baker,  terms  it,  the  sponge  rises.  When 
the  sponge  is  in  active  fermentation  it  is  ^thoroughly 
kneaded  with  the  remainder  of  the  flour,  salt  and 
water,  and  again  set  aside  for  a  few  hours  in  a  warm 
situation.  Fermentation  extends  throughout  the 
whole,  and,  at  the  proper  moment,  the  dough  is  made 
into  loaves  aiid  introduced  into  the  oven.  Herein 
constitutes  one  of  the  chief  points  in  the  -baker's  art. 
Uidess  fermentation  lias  been  allowed  to  proceed  far 
enough,  a  heavy  loaf  is  the  result ;  and  if  allowed  to 
proceed  too  far,  an  objectionable  quality  is  given  to 
the  bread  by  the  commencement  of  another — an  acid 
fermentation.  This  is  said  to  1)6  more  likely  to  occur, 
with  the  formation  of  acetic,  butyric  and  lactic  acids, 
when  "  leaven "  has  been  used  as  the  ferment,  and 
that  bread  so  made  has,  as  a  rule,  a  more  or  less  sour 
taste.  The  alcohol  is  driven  off  by  the  heat  of  the 
oven  in  baking.  The  best-flavoured  bread  is  said  to 
be  that  made  with  brewer's  yeast. 

The  necessary  porosity  may  also  be  given  to  the 
dough  by  the  use  of  baking  powder  for  the  evolution 
of  carbonic  acid  gas.  Borwick's  baking^  powder  con- 
sists of  a  mixture  of^carbonate  of  soda  and  tartaric 
acid ;  and  Liebig's,  which  is  by  some  considered  more 
wholesome,  of  a  mixtuj-e  of  the  acid  phosphate  of 
calcium  with  carbonate  of  soda  and  chloride  of 
pota.ssium  ;  or  carbonate  of  ammonia  may  be  mixed 
with  the  dough,  and  hydrochloric  acid  added.  The 
bi'ead  thus  made  has  a  less  agreeable  taste  than  that 
made  by  fermentation,  and  it  is  a  process  rarely 
employed  by  bakers. 

Dauglish's  process,  which  is  now  largely  carried 


Chap.  VII.]  Bread-Making.  *         167 

out  by  the  Aerated  Bread  Company,  consists  in  forcing 
carbonic  acid  through  the  dough  by  pressure,  and  it 
claims  as  one  of  its  recommendations  that  the  manipu- 
lation of  the  dough  by  the  hands  of  the  baker  is 
avoided.  It  is  also  considered  to  have  the  advantage 
over  fermentation,  that  it  is  impossible  for  the  con- 
version of  starch  into  dextrin,  sugar,  and  lactic  acid 
to  go  too  far.  About  twenty  cubic  feet  of  carbonic 
acid,  derived  from  chalk  and  sulphuric  acid,  are  used 
for  280  pounds  of  flour,  and  about  eleven  cubic  feet 
are  actually  incorporated  with  the  flour.  It  is  said  to 
keep  sweet  and  good  much  longer  than  fermented 
bread,  but  it  has  a  peculiar  taste,  and  lacks  the 
pleasant  flavour  of  the  best  fermented  bread ;  more- 
over, it  is  always  diier,  and  in  keeping  even  for 
a  short  time  becomes  very  hard  and  brittle.  Salt 
is  usually  add/^d  to  bread  to  improve  its  flavour 
and  appearance,  giving  it  greater  whiteness  and 
fiiinness. 

The  eflect  of  the  heat  applietl  in  baking,  on  the 
constituents  of  the  flour,  is  to  increase  their  digesti- 
bility, the  nitrogenous  constituents  are  changed, 
the  starch  granules  are  ruptured,  and  a  portion 
of  the  starch  is  converted  into  dextrin  and  grape 
sugar. 

Bread  varies  much  both  in  its  digestibility  and 
nutritive  properties,  just  as  it  differs  also  in  its 
physical  appearance  and  chemical  composition.  These 
differences  depend  partly  on  the  mode  of  preparation 
and  partly  on  the  kind  of  meal  employed. 

Badly-made  bread  is  often  the  cause  of  dys[)epsia ; 
the  fermentative  changes  continue  in  the  stomach 
with  generation  of  carbonic  acid  gas,  and  consequent 
flatulence,  heartburn,  and  acid  eructations.  This  has 
been  attributed  to  the  use  of  unwdiolesome  yeast  ; 
and  it  has  been  urged  in  favour  of  aerated  bread 
made  by  the  Dauglish  method  that  it  is  free  from 
such  risks;  but  bread  may  certainly  be  badly  male, 
and  on  that  account  indigestible,  without  the  fault 
being  necessarily  in  the  yeast.     It  is  undoubtedly  a 


1 68 


I'OOD  IN  Health. 


(Part  I. 


great  drawback  to  the  use  of  the  coarser  meals  and  of 
whole  meal  for  making  bread  that  such  bread  is  often 
indigestible  and  heavy,  and  productive  of  dyspepsia 
in  some  persons  of  feeble  digestion.  This  is  probably, 
in  great  measure,  due  to  the  diminished  porosity  of 
such  bread,  for  it  seems  to  resist  aeration  and  vesicu- 
lation  to  the  same  degree  as  is  common  in  the  best 
qualities  of  white  bread.  Bauer  observes  of  bread 
made  of  coarse,  adhesive  meal  : — "  Such  adhesive 
breads  are  very  imperfectly  utilised  by  the  human 
organs  of  digestion,  since  the  irritation  they  cause  to 
the  mucous  membrane  of  the  alimentary  canal  leads 
to  a  rapid  progress  and  early  evacuation  of  its  con- 
tents " — a  property,  however,  often  "  usefully  em- 
ployed to  overcome  habitual  sluggishness  of  the 
bowels." 

Dujardin- Beaumetz  also  protests  against  the 
common  error  that  the  coarser  kinds  of  household 
bread  are  more  nutritious  than  the  very  fine  white 
"fancy  "  breads  (jmins  de  luxe). 

In  the  first  place,  it  must  be  remembered  that 
such  bread  is  prepared  and  baked  with  unusual  cai'e 
and  skill,  and  is  thoroughly  aerated  and  light,  and 
thereby  rendered  more  easy  of  digestion.  In  the 
second  place,  it  would  seem  to  be  richer  in  nitro- 
genous constituents.  The  following  figures,  comparing 
the  percentage  proportion  of  nitrogen  in  three  quali- 
ties of  bread — seconds,  firsts,  and  "  fancy  "  bread — 
are  quoted  by  Dujardin-Beaumetz  from  Violet  ("  Sur 
le  Pain  ")  :— 

Percentage  of  Nitrogen. 


Seconds. 

Firsts. 

"  Fancy." 

1st  Specimen        

2nd      „                

3id       „                

0-92 
0-99 

1-11 
1-36 
102 

1  -39 

2  06 
l-2o 

Average        

0-99          116          l-o7 

Chap.  VII.] 


Bread-Making. 


169 


The  composition  of  some  different  kinds  of  bread 
is  thus  given  by  Bauer  :*  in  100  parts — 


1 

C  ai 

t 

CI 

Ui 

to 

3     . 

m 

B 

40-97 

f 

1 

Fine  Wheaten  Bread 

38-51 

6-8-2 

0-77 

2-37 

0-38 

1-18 

English  „             „ 

87-00 

8-10 

1-60 

3-6 

47-40 

— 

2-30 

Coarjo     ,,            ,, 

41-0-2 

6-23 

0-22 

2-13 

48-69 

0-62 

1-09 

Kye  Bread           „ 

44-02 

6-09 

0-48 

2-54 

45-33 

0-30 

1-31 

A  great  deal  has  been  written,  without  very  much 
reflection  and  without  any  very  great  regard  to  accu- 
racy, about  the  evils  attending  the  separation  of  the 
"bran,"  or  outer  coat  of  wlieat,  from  the  flour  of 
which  bread  is  made.  It  has  been  urged  that  not 
only  is  this  practice  very  wasteful,  but  that  it  leads 
to  the  loss  in  the  bread  made  from  such  flour  of 
much  of  the  most  important  nutritive  constituents 
of  the  grain  ;  and,  indeed,  it  is  admitted  that  the 
bran  is  rich  in  nitrogenous  (15  per  cent.),  fatty  (3-5 
per  cent.),  and  mineral  substances  (6-7  per  cent., 
chiefly  phosphates).  But,  as  has  been  pointed  out 
by  Parkes  and  others,  if  the  "  bi'an  "  is  used,  much  of 
it  is  probably  entirely  undigested,  and  it  can  therefore 
yield  but  little  nutriment,  and  that,  unless  ground 
very  fine,  the  outer  envelopes  of  the  grain  are  very 
irritating,  and  especially  unsuited  to  sick  pei-sons 
with  any  tendency  to  intestinal  irritation  ;  indeed, 
according  to  Pai-kes,  "  dysenteries  have  been  found 
most  intractable  merely  from  attention  not  being 
directed  to  this  siuiple  point."  The  method,  now 
extensively  adopted,  of  decorticaliny  the  grain — 
that  is,  of  removing  the  two  or  three  outer  highly 
silicious  envelopes  and  leaving  the  fourth  or  inner 
envelope — has  certaiidy  more  to  recommend  it,  and  it 

•  Abstracted  from  a  larger  table  in  his  "  Dietary  of  the  Sick." 


I70  Food  in  Health.  [Pani. 

no  doubt  yields  a  meal  very  suitable  for  bread-making, 
especially  for  young  and  growing  persons  with  sound 
and  active  digestions;  but  we  have  seen  some — other- 
wise very  pleasant — bread  made  from  such  decorti- 
cated whole-wheat  meal  prove  very  indigestible  to 
adults  leading  sedentary  lives.  It  makes  a  bread 
which  is  usually  heavier,  moister,  and  of  closer 
texture  than  that  made  from  the  finest  white 
flour. 

Sir  Henry  Thompson  advocates  strongly  that  the 
bread  of  the  labourer  should  be  made  from  entire 
wheat  meal ;  "  but  it  should  not  be  so  coarsely 
ground  as  that  commonly  sold  in  London  as  '  whole 
meal.'  This  coarse  meal  does  not  readily  produce 
light,  agreeable  bread  when  made  in  the  form  of  ordi- 
nary loaves  :  a  solid,  mass  of  this  meal,  being  a  bad 
conductor  of  heat,  will  have  a  hard,  flinty  crust  if 
baked  sufliciently  to  cook  the  interior ;  or  it  will 
have  a  soft,  dough-like  interior  if  the  baking  is 
checked  when  the  crust  is  properly  done.  Con- 
sequently the  form  of  a  flat  cake,  resembling  that 
of  the*ordinary  tea-cake,  is  preferable,  since  it  admits 
of  the  right  amount  of  heat  operating  equally  through- 
out the  mass.  The  following  recipe  will  be  found 
successful,  probably  after  a  trial  or  two,  in  pro- 
ducing excellent,  light,  friable,  and  most  palatable 
bread  : — To  2  lb.  of  coarsely-ground  or  crushed  whole 
wheat-meal,  add  half-a-pound  of  fine  flour  and  a 
suflicient  quantity  of  baking  powder  and  salt ;  when 
these  are  well  mixed,  rub  in  about  2  oz.  of  butter, 
and  make  into  dough  with  half  milk  and  water,  with 
skimmed  milk  (warm),  or  with  all  milk,  if  preferred. 
Make  into  flat  cakes  like  '  tea  cakes,'  and  bake  with- 
out delay  in  a  quick  oven,  leaving  them  afterwards 
to  finish  thoroughly  at  a  lower  temperature.  The 
butter  and  milk  supply  fatty  matter,  in  which  the 
wheat  is  somewhat  deficient.  A  palatable  addition 
is  made,  in  my  opinion,  by  exchanging  the  half  a- 
pound  of  flour  ordered  in  the  foregoing  recipe  for 
the  same  quantity    of  medium-fine    Scotch    oatmeal. 


Chap  VII.]  Bread-Making.  171 

TJie  change  adds  to  the  brittleness  and  lightness  of 
the  product" 

The  baking  jjowder  is  made  by  mixing  well  to- 
gether— Tartaric  acid,  2  oz.  ;  bicarbonate  of  soda, 
3  oz.  ;  common  arrowroot,  3  oz.  Keep  perfectly  dry 
in  a  wide-mouthed  bottle. 

The  advantages  of  bread  as  an  article  of  diet  are 
familiar  to  everyone.  It  contains  a  large  amount  of 
albuminates  and  carbohydrates  ;  the  nitrogen  is  in 
the  proportion  of  1  to  21  of  the  carbon,  so  that  the 
addition  of  some  nitrogen  would  be  necessary  to  make 
it  a  perfect  food.  It  is  deficient  in  fat  and,  if  the 
outer  coverings  of  the  grain  are  entirely  removed,  in 
mineral  substances.  But  man  never  tires  of  its  use, 
probably  because  of  the  great  variety  of  its  constituents. 

A  further  cooking  of  bread  in  the  form  of  toasting 
is  often  resorted  to,  and  it  appears  to  increase  its 
digestibility  ;  there  is  a  further  loss  of  water,  and  the 
surfaces  are  scorched,  and  the  bread  is  made  firmer 
and  crisper.  It  should  be  toasted  in  slices  thin  enough 
to  be  made  crisp  all  through ;  when  they  are  thick 
the  central  part  becomes  soft  like  new  bread.  New 
bread  is  well  known  to  be  less  digestible  than  stale  ;  the 
former  being  soft  and  moist  is  more  difficult  of  mastica- 
tion and  insalivation,  as  it  tends  to  clog  together  in 
heavy  adhesive  masses  which  are  not  porous  enough  to 
allow  of  the  free  access  of  the  digestive  juices.  Bread, 
when  stale,  has  the  peculiar  property  of  becoming 
soft  and  like  new  bread  on  rebaking  or  exposing  for 
a  short  time  to  a  high  temperature ;  this  has  been 
accounted  for  on  the  liypothesis  that  when  bread  gets 
dry  by  keeping,  the  water  entei-s  into  chemical  com- 
bination with  the  solid  constituents,  for  if  it  were 
due  to  evaporation  of  the  contained  water,  it  would 
be  impossible  to  make  it  appear  fresh  and  new  by 
re-heating. 

Wheat  flour,  and  the  meal  of  other  cereals,  is 
also  cooked  in  various  other  ways  besides  being  made 
into  bread.  Biscuit,  as  the  name  signifies,  is  made 
of  dough  which  Is  baked  much  longer,  and  is  harder 


172  Food  w  Health.  cParti. 

and  drier  than  oi'dinary  bread,  so  that  it  can  be 
preserved  for  a  much  longer  time.  In  the  French 
army,  besides  the  pain  de  muniiioit,  or  ordinary 
bread,  which  is  reckoned  to  keep  from  five  to  eight 
days,  according  to  the  season,  they  have  when  on 
active  service  pain  biscuite,  which  will  keep  forty  to 
fifty  days.  They  have  also  pain  demi-biscuite,  which 
can  be  preserved  twenty  to  thirty  days. 

The  simplest  kind  of  biscuit  is  made  of  flour  and 
water  only,  or  a  very  little  butter  is  added  to  prevent 
it  from  becoming  too  dry  and  hard.  Such  is  the 
ordinary  "  ship  "  or  sailor's  biscuit.  The  advantages 
of  biscuit  of  this  kind  are  that  it  contains  but  little 
water,  and  is  therefore,  bulk  for  bulk,  more  nutritious 
than  bread,  three-quarters  of  a  pound  of  biscuit  being 
eqviivalent  to  one  pound  of  bread ;  it  occupies  less 
space,  and  is  more  transportable.  Its  disadvantages 
are,  that  it  tends,  by  keeping,  to  get  very  hard  and 
dry,  and  to  become,  after  long  restriction  to  its  use, 
unpalatable  and  indigestible,  and  it  is  found  better 
for  the  health  of  troops  to  issue  a  bread  ration  when- 
ever possible,  and  to  use  biscuit  only  when  bread 
cannot  be  procured.  Parkes  calls  attention  to  the 
value  of  "unfermented  cakes"  made  simply  with 
water  and  salt,  as  a  substitute  for  biscuit  in  war  time. 
They  are  palatable,  nutritious,  and  readily  made  ;  and 
he  thinks  every  soldier  should  be  taught  to  make 
them.  "The  Australian  damper  is  simply  made  by 
digging  a  hole  in  the  ground,  filling  it  with  a  wood 
fii-e,  and  when  the  tire  has  thoroughly  burnt  up, 
remo\ing  it,  placing  the  dough  on  a  large  stone, 
covering  it  with  a  tin  plate,  and  heaping  the  hot 
ashes  round  and  over  it.  In  a  campaign  every  soldier, 
if  he  could  get  flour  and  wood,  would  soon  learn  to 
bake  a  cake  for  himself.  The  only  point  of  manipu- 
lation which  requires  practice  is  not  to  have  the  heat 
too  great ;  if  it  be  above  212°  F.,  too  much  of  the  starch 
is  changed  into  dextrin,  and  the  cake  is  tough.  Ex- 
posed to  greater  heat  and  well  dried,  the  unfermented 
cakes  become  biscuit." 


Chap.  VII.)       Macaroni,   Vermicelli,  etc.  173 

Various  other  kinds  of  biscuit  are  prepared  in 
whicli  sugar,  eggs,  milk,  etc.,  enter  as  constituents,  and 
sometimes  baking  powder  or  carbonate  of  ammonia 
(on  account  of  its  volatility)  is  added  to  the  dough 
to  give  them  porosity  and  lightness. 

Puddings,  pastry,  sweet  cakes,  etc.,  are  made  of 

flour  mixed  with  butter,  eggs,  sugar,  and  other  sub- 

'    stances.     These  are  cooked  at  a    high    temperature, 

^    being  usually  baked  or  boiled,  and  the  flour  undergoes 

>    similar  changes  to  those  which  occur  in  making  bread. 

They  are,  however,  generally  rich,  and  apt  to  cause 

<     stomach  disturbances,  particularly  in  the  dyspeptic. 

Pastry  is  especially  unwholesome  on  account  of  the 

4   changes  which  the  heat  of  the  oven  causes  in  the  fats 

.  mixed  with  it ;    and  boiled   pudding  or  paste  is  in- 

'  digestible  because  it  usually  forms  a  solid  tenacious 

mass,  not  porous  like  bread,  and  is  penetrated  with 

difficulty  by  the  digestive  fluids. 

Macaroni,  Vermicelli,  Pate  d'ltalie,  etc., 
are  all  preparations  of  flour  usually  made  from  hard 
Italian  wheat,  i-ich  in  gluten.  A  stiff'  paste  is  made 
with  flour  and  hot  water,  and  this  is  pressed  through 
holes  in  metal  plates,  or  stamped  into  various  forms, 
heat  being  applied  at  the  same  time.  They  have  the 
advantage  of  keeping  well  and  being  very  nutri- 
tious in  small  bulk,  and  so  are  convenient  for  trans- 
port. 

Of  macaroni  Sir  H,  Thompson  observes: — "It 
is  certainly  to  be  lamented  that  so  little  use  is  made 
in  our  country  of  Italian  pastes.  Macaroni  in  all  its 
forms  is,  in  fact,  an  aliment  of  very  high  nutritious 
power,  being  formed  chiefly  of  gluten,  the  most  valu- 
able part  of  the  wheat  from  which  the  starch  has  been 
removed.  Weight  for  weight  it  may  be  regarded  as 
not  less  valuable  for  flesh-making  purposes,  in  the 
animal  economy,  than  beef  or  mutton.  Most  people  can 
digest  it  more  easily  and  more  rapidly  than  meat ;  it 
offers  therefore  an  admirable  substitute  for  meat,  par- 
ticularly for  lunch  or  mid-day  meals.  .  .  Macaroni 
might  with  advantage  be  prepared  at  restaurants  as  a 


174  Food  in  Health.  iPani. 

staple  dish  in  two  or  three  forms,  since  it  sustains  the 
power  without  taxing  too  much  the  digestion.  One 
of  the  best  forms  for  serving  it  is  that  known  as 
WMcarcmi  d,  VJtalienne."  * 

Many  kinds  of  farinaceous  foods  are  prepared  by 
boiling  with  milk,  eggs,  etc.,  and  served  in  semi-fluid 
form  easy  of  digestion,  and  very  suitable  for  invalids?, 
young  children,  and  i)ersons  of  delicate  digestion. 
Oatmeal  gruel,  rice-milk,  and  milk  pudfUngs  made 
with  sago,  arrowroot,  tapioca,  macaroni,  etc.,  afford 
very  useful  foods,  especially  appropriate  to  states  of 
convalescence,  and  as  a  transition  from  tluid  to  solid 
foods. 

Rice  requires  to  be  cooked  carefully,  or  the  grains 
will  remain  hard  and  indigestible ;  thorough  steam- 
ing, so  that  the  starch  granules  shall  be  completely 
swollen,  is  the  best  process  to  adopt. 

Peas  and  beans  also  require  thorough  boiling, 
slowly,  and  for  a  long  time,  in  order  to  be  made  diges- 
tible. If  old,  no  amount  of  boiling  will  soften  them  ; 
they  must  then  be  soaked  in  cold  water  for  twenty-four 
hours,  crushed  and  stewed. 

The  potato,  a  vegetable  rich  in  starch,  also  requires 
careful  cooking.  Steaming  is  the  best  method,  as 
there  is  tlien  no  loss  of  salts,  but  the  heat  should 
be  moderate.  If  boiled,  it  should  be  in  their  skins 
to  prevent  the  loss  of  salts,  and  the  boiling  must  be 
thorough  or  the  starch  granules  will  remain  indiges- 
tible ;  and  also  slow,  otherwise  the  cellulose  and 
albuminates  will  be  hard. 

"  Maslied  potatoes  "  is  a  useful  method  of  serving 
this  vegetable,  as  it  effectually  gets  rid  of  the  hard 
indigestible  masses  into  which  a  badly  cooked  or 
imperfectly  masticated  potato  is  apt  to  reach  the 
stomach. 

Most  fresh  green  vegetables  and  edible  roots  are 
boiled  in  water  according  to  definite  culinary  rules, 
and  their  digestibility  and  wholesomeness  depend 
greatly  on    their   being   well    and    carefully    cooked. 

*  A  recipe  for  making  this  will  be  found  in  tlio  Appendix. 


Chap.  VII.]  Preheri'ation  OF  Food.  175 

Tliey  should  be  selected  young  and  tender,  and  boiled 
sutiiciently  to  acquire  the  necessary  softness.  Their 
digestibility  is  greatly  increased,  and  their  irritating 
properties  avoided  by  reducing  them  into  the  form  of 
•purees  whenever  this  is  possible. 

Vegetables  of  the  cabbage  tribe  give  a  peculiarly 
disagreeable  odour  to  the  water,  "  green-water,"  in 
which  they  are  boiled,  so  that  they  must  be  boiled 
alone  and  the  water  thrown  away. 

Salads  are  prepared  both  with  cooked  and  un- 
cooked vegetables,  and  are  usually  "  dressed  "  with  a 
mixture  of  oil,  vinegar,  and  other  condiments.  They 
are  useful  for  stimulating  appetite,  and  giving  reli.sh 
to  other  food,  but  they  do  not  constitute  suitable 
food  for  invalids,  as  they  are  somewhat  difficult  of 
digestion. 

Many  fruits  are  also  submitted  to  a  cooking 
process,  in  order  to  soften  them  and  make  them  more 
easy  of  digestion. 

The  preservation  of  food.— Various  means 
liave  at  all  times  been  adopted  by  the  human  race  to 
prevent  or  retard  the  decomposition  of  food  sub- 
stances, so  as  to  render  them  transportable  from  place 
to  place,  or  to  store  them  up  when  procurable  in 
abundance,  for  use  in  periods  of  scarcity,  or  to  pre- 
serve them  from  one  season  to  another. 

By  the  application  of  the  various  means  available 
for  preserving  foods,  the  produce  of  different  countries 
becomes  interchangeable,  and  the  over-abundance  of 
one  region  supplies  the  deficiencies  of  another ;  and, 
indeed,  a  great  part  of  the  world's  commerce  consists 
in  the  transpoi-t  of  food  supplies  between  distant 
countries.  Foods  that  contain  very  little  water,  such 
as  various  cereal  grains  and  the  pulses,  only  require  to 
be  kept  dry  and  clean,  in  order  to  remain  sound  and 
in  a  good  state  of  preservation  for  long  periods,  but  all 
kinds  of  food,  both  animal  and  vegetable,  into  the 
composition  of  which  water  enters  largely,  can  only  be 
pi-evented   from   undergoing   decomposition    for  any 


176  Food  in  Health.  [Parti. 

considerable  time  by  special  methods  of  preservation. 
These  methods  are  mainly  four  in  number  : — 

1.  The  method  of  drying  food,  or  getting  rid 

of  the  greater  part  of  the  water  contained 
in  it. 

2.  The  exclusion  of  atmospheric  air  ;  or,  what 

amounts  to  the  same  thing,  covering  the 
food  with  an  impermeable  coating. 

3.  Exposure  to  cold. 

4.  Treatment  with  antiseptic  chemical  agents. 

1 .  Some  of  these  methods  are  frequently  combined. 
Drying  by  exposure  to  the  air  is  a  very  ancient  and 
very  primitive  method  of  preserving  animal  food,  and  is 
practised  largely  in  savage  or  half-civilised  communi- 
ties. In  countries  where  the  air  is  dry  and  pure,  and 
the  solar  radiation  intense,  it  is  a  ready  and  con- 
venient method;  the  meat  is  simply  cut  into  slices  and 
exposed  to  the  air.  Tlie  Kaffirs  thus  preserve  large 
masses  of  beef  that  have  been  sun-dried.  The 
Egyptians  also  preserve  meat  by  exposing  it  to  the 
sun  and  north  wind. 

Cha7'qui  is  the  name  given  in  South  America  to 
strips  and  slices  of  beef,  freed  from  fat  and  di-ied 
rapidly  by  sun  heat,  and  sprinkled  with  maize.  Tasajos 
is  also  a  preserved  meat  prepared  in  South  America, 
by  cutting  it  in  thin  slices,  then  dipping  it  in  brine  and 
partially  drying.  Pemmican,  a  food  used  by  Arctic 
travellers,  consists  of  a  mixture  of  the  best  beef  and 
fat  fried  together,  and  is  very  nutritious,  but  costly. 
Sugar  is  sometimes  added  to  it,  as  well  as  raisins 
and  curiants,  which  increases  its  value  when  fresh 
vegetables  are  not  procurable. 

Meat  may  also  be  dried  at  a  very  low  heat ;  it 
gets  very  hard  from  having  lost  the  greater  part  of 
its  water,  and  requires  careful  cooking. 

There  is  a  preparation  of  dried  meat  by  M'Call,  of 
London,  which  retains  12  per  cent,  of  water,  and  is 
flavoured  with  jxjpper  and  salt.  It  is  sold  in  4  oz. 
packets,  and  i.s  said  to  l>e  very  good  and  nutritious. 


Chap. VII.)  Preservation  of  Food.  iff 

The  French  use  powdered  dried  meat  largely  for 
adding  to  invalids'  foods.  La  poudre  de  viande 
Rousseau  is  one  of  the  most  popular  ;  it  is  said  to  keep 
for  any  length  of  time,  to  be  of  an  agreeable  odour  and 
taste,  and  to  be  readily  digested. 

There  are  also  the  Poudres  de  bifteck  et  de  viaude 
Adrian,  the  former  being  prepared  from  French  beef, 
the  latter  fx'om  American. 

IlassalVs  flour  of  meat  is  analogous  to  these  pre- 
parations. It  is  said  by  Parkes  to  be  composed  of 
good  fresh  meat,  freed  from  visible  fat,  and  carefully 
dried  at  a  very  low  temperature,  and  pulverised  by 
machinery,  so  as  to  form  a  very  fine,  smooth  powder. 
This  is  mixed  with  about  8  per  cent,  of  arrowroot,  2i 
per  cent,  of  sugar,  and  3  per  cent,  of  a  mixture  of  salt, 
pepper,  spices,  and  colouring  matter.  The  object  of 
the  airosvroot  is  to  assist  its  suspension  in  water.  It 
keej)s  well  in  tins,  but  it  .should  not  be  exposed  to  the 
air  for  long  at  a  time. 

Bread  is  also  preserved  by  drying  ;  the  "  pain 
biscuite"  of  the  French  army  is  bread  dried  by  heat,  and 
bread  from  which  the  water  has  been  partially  pressed 
out  by  hydraulic  pressure  will  keep  good  for  years. 

Potatoes,  too,  are  preserved  by  drying.  They  are 
either  in  slices  or  granulated.  This  preparation  is 
easily  cooked  (should  be  steamed,  after  soaking  in  cold 
waler)  and  is  very  palatable.  Analyses  niade  by  Pro- 
fessors Atttield  and  De  Chaumont  showed  that  one 
pound  of  preserved  potatoes  contained  the  solid  matter 
of  three  and  a  half  pounds  of  ordinary  fresh  potatoes. 

Other  vegetables  can  be  dried  and  compressed,  such 
as  peas,  cauliflower,  carrots,  etc.,  and  so  successfully, 
that  those  of  Massou  and  Challott,  if  properly  cooked, 
are  aluiost  equal  to  fresh  vegetables.  They  must  l)e 
cooked  very  slowly.  Professor  Atttield's  analy.sis 
showed  that  dried  compressed  cabbage  contained  th" 
solids  of  seven  times  its  weight  of  fresh  cabbage,  and 
the  mixed  vegetables  five  and  a  half  times  the  solids 
of  the  fresh  vegetables.  The  experience  of  the 
American    war  showed    that  as   anti-&corl>utics  thev 


178  Food  in  Health.  (Parti. 

were  much  better  than  nothing,  but  inferior,  however, 
to  fresh  vegetables.  Vegetables  preserved  in  bulk, 
without  drying,  are  mucli  better  as  food,  and  as  anti- 
scorbutics, 

MU,k  can  also  be  preserved  by  drying,  and  is  sold 
as  a  powder. 

Eggs  can  be  dried,  but  the  yolk  does  not  keep  well. 
Mixed  with  flour,  ground  rice,  etc.,  both  yolk  and 
white  can  be  dried  and  preser\ed. 

The  drying  of  fruits  is  a  very  well-known  means 
of  preserving  them. 

A  combination  of  drying,  salting,  and  smoking  is 
a  very  common  domestic  method  of  preserving  several 
kinds  of  animal  food. 

2.  The  exclusion  of  air  is  another  largely  employed 
method  of  preserving  food.  The  immersion  of  tish 
(previously  somewhat  salted)  in  oil,  the  covering  of 
potted  meats  with  a  layer  of  melted  fat,  are  familiar 
illustrations  of  this  process.  By  simply  exposing  the 
surface  of  meat  to  a  strong  heat,  so  as  to  coagulate  the 
outside  albuminous  layei's,  it  can  be,  on  this  princi})le, 
kept  for  some  time. 

Any  means  by  which  foods  can  be  covered  with 
an  impermeable  coating,  and  so  protected  from  the 
action  of  the  air,  will  usually  preserve  them  for  a  long 
time ;  in  this  way  by  coating  eggs  with  a  solution  of 
bees'  wax  in  warm  olive  oil  (one-third  of  bees'  wax  to 
two-thirds  of  olive  oil)  they  may  be  preserved  for  two 
years.  Eggs  are  also  preserved  by  packing  in  sawdust 
or  salt,  or  by  covering  them  with  gum,  butter,  or  oil, 
indeed  anythdng  which  excludes  air.  A  modification 
of  this  method  is  one  described  by  Parkes.  "  Meat 
being  cut  into  smaller  portions  and  placed  in  a  large 
vessel,  heat  should  be  applied,  and  while  hot,  the 
mouth  of  the  vessel  should  be  closed  tightly  with  well- 
washed  and  dried  cotton -wool ;  the  air  is  filtered,  and 
partially  freed  from  germs."  Covering  the  whole 
surface  of  meat  with  a  coating  of  paraffin,  or  embedding 
it  in  powdered  charcoal,  is  also  a  preservative  measure 
representing  applications  of  this  method.     Tinned  and 


Chap.  VII.]         Preservation  OF  Food.  179 

bottled  provisions  are  all  preserved  on  the  principle 
of  the  exclusion  of  air.  The  food  to  be  preserved 
having  been  introduced  into  a  suitable  vessel,  heat  is 
applied  so  as  to  generate  steam,  in  order  to  drive  out 
the  air,  the  opening  of  the  vessel  is  then  closed  and 
made  air  tight. 

What  is  known  as  Appert's  process  consists  simply 
in  the  complete  exclusion  of  air.  M'Call's  process 
consists  in  partial  exclusion  of  air,  and  acting  on  the 
residue  by  sodium  sulphite ;  this  latter  process  avoids 
the  application  of  so  high  a  temperature  as  is  needed 
in  the  former.  Another  method  is  to  draw  ott'  the  air 
and  substitute  a  mixture  of  nitrogen  and  a  little  sul- 
phurous acid  in  its  place.  Meat,  fruit,  vegetables, 
and  all  kinds  of  provisions  may  be  preserved  for  a 
great  length  of  time  by  application  of  this  method- 
Milk  may  be  kept  in  the  same  way,  but  the  butter  is 
apt  to  separate,  and  this  may  be  })re vented  by  con- 
centrating the  milk  and  adding  some  sugar.  It  is 
usual  to  add  about  80  grammes  of  cane  sugar  to  one 
litre  of  milk,  and  evaporate  the  whole  to  one-fifth  of 
its  volume,  and  it  is  sealed  up  while  hot  in  air-tight 
tins;  when  given  to  children  a  suitable  proportion  is 
first  dissolved  in  cold  water  and  then  boiled.  By 
Loefflund's  process  it  is  preserved  unsweetened. 

3.  Another  method  is  the  application  of  cold.  It 
is  a  well-known  domestic  expedient  to  keep  perishable 
food  substances  on  ice,  and  fish  is  invariably  packed 
in  ice  to  convey  it  to  market,  and  to  preserve  it  fresh 
until  cooked.  In  ice,  meat  can  be  preserved  for  an 
unlimited  period,  and  the  supposed  tendency  to  rapid 
decomposition  after  thawing  ajjpears  to  have  been 
exaggerated.  It  is,  however,  certain  that  frozen  meat 
loses  about  10  ])er  cent,  more  in  cooking  than  freshly- 
killed  meat.  Large  quantities  of  meat  are  now  im- 
ported from  America  and  Australia  in  refrigerating 
chambers.  The  refrigerating  chamber  is  now  an 
essential  part  of  the  equipment  of  ocean-going  steamers, 
and  thanks  to  it  passengers  can  now  be  provided  with 
fresh  provisions  cdl  through  the  voyage. 
m2 


i8o  Food  in  Health.  iParti. 

4.  And  lastly,  there  is  the  method  of  preservation 
by  antiseptic  chemical  agents,  a  method  which  is  often 
combined  with  one  of  the  others.  Salting  and  smoking, 
associated  often  with  drying,  represent  the  earliest 
efforts  in  this  direction.  Salting  is  one  of  the  oldest 
methods  of  preserving  meat ;  a  small  quantity  of  salt- 
petre is  usually  added  to  the  common  salt  to  preserve 
a  red  colour  in  the  flesh.  Smoking  is  usually  applied 
after  salting.  The  creosote  and  other  constituents  of 
the  smoke  penetrate  the  substance  exposed  to  it,  and 
exercise  a  highly  antiseptic  and  preservative  action 
upon  it.  A  certain  amount  of  drying  and  coagulation 
of  the  albumen  on  the  surface  occurs  at  the  same  time. 

One  of  the  great  objections  to  salting  is  that  a 
portion  of  the  salts  and  extractives,  and  a  considerable 
amount  of  the  albuminates,  pass  out  into  the  bi'ine. 
Analysis  of  the  brine  has  shown  that  it  contains  much 
of  the  nutritious  principle  of  the  meat,  both  organic 
and  mineral.  Liebig  estimated  the  nutritive  loss  at 
one-third  or  more.  Kiihne  has  found  that  myosin  is 
soluble  in  a  10  per  cent,  solution  of  chloi'ide  of  sodium  ; 
lience  a  large  quantity  of  this  substance  necessarily 
passes  into  the  brine.  The  muscular  fibre  is  also 
hardened  by  the  salt,  and  rendered  indigestible. 
Parkes  considers  salt  beef  to  be  of  rather  less  than 
two-thirds  the  value  of  fresh  beef  Whitelaw  was 
able  to  obtain  by  dialysis  a  large  quantity  of  flesh 
extract  from  the  brine  of  salt  beef  ;  from  two  gallons 
of  brine  a  fluid  was  obtained  which,  on  evaporation, 
yielded  one  pound  of  extract. 

Brine  has  sometimes  been  found  to  be  poisonous ; 
this  occurs  when  it  has  been  used  over  and  over  again. 
A  large  (juantity  of  animal  substance  passes  into  it 
and  appears  to  decomj)ose,  but  no  special  poisonous 
agent  has  been  isolated.  Another  important  con- 
sideration is  that  the  long-continued  use  of  salted  meat 
le^ds  to  a  deterioration  of  health,  and  the  development 
of  scurvy. 

The  flesh  of  the  hog,  however,  seems  especially 
adapted  to  salting  and  smoking,  and  its  digestibility 


Chap.  VII.]         Preservation  of  Food.  i8i 

and  wholesomeness  are  increased  rather  than 
diminished  thereby.  Bauer  speaks  of  "  smoked  bacon 
as  one  of  the  wholesomest  forms  of  meat.  Whether 
boiled  or  eaten  raw,  it  seems  as  a  rule  to  be  more 
easily  digested  by  weak  organs  than  almost  any  other. 
It  appears  to  me  not  improbable  that  the  flesh 
becomes  more  digestible  in  the  process  of  smoking." 

Fish,  such  as  salmon,  herrings,  cod,  haddock, 
sprats,  and  many  other  kinds,  are  preserved  in  vast 
quantities,  by  salting  and  smoking  together,  or  by 
salting  alone. 

Immersion  in  vinegar,  alcohol,  or  strong  syrup,  the 
application  of  sugar  to  the  surface,  are  also  common 
expedients  for  preserving  both  animal  and  vegetable 
foods. 

There  are  many  other  antiseptic  agents  used  for 
preserving  food,  such  as  the  vajmur  of  sulphur,  the 
meat  being  placed  in  a  close  vessel  in  which  sulphur  is 
burnt ;  or  charcoal,  which  is  dusted  over  its  surface  ; 
or  strong  acetic  acid  ;  or  calcium  disulphide-;  or  weak 
carbolic  acid.  Injection  of  alum  and  chloride  of 
aluminum  into  the  blood-vessels  will  preserve  meat 
for  a  long  time  ;  water  should  be  injected  first  and  the 
antiseptic  solution  afterwards.  Borax,  boric  acid  and 
salicylic  acid  have  all  been  used  for  the  preservation 
of  food. 

Aspptin,  a  powder,  and  Aseptin  amykos,  a  liquid 
Swedish  nostrum,  used  in  the  preservation  of  food, 
both  owe  their  antiseptic  properties  to  boric  acid. 
Thi.s  acid  is  also  used  largely  in  England  and  other 
countries  for  preserving  milk.  It  is  regarded  by  most 
authorities  as  harmless.  A  substance  termed  Boro- 
glyceride,  a  preparation  patented  by  Barff  in  England 
and  Le  Bon  in  France,  is  made  by  heating  together 
boric  acid  (fi2  parts)  and  glycerine  (92  parts).  It 
forms  a  tough,  deliquescent  mass,  readily  soluble  in 
water  and  alcohol ;  and  in  solution  in  water  in  the 
proportion  of  one  to  forty  it  is  extensively  used  as  an 
antiseptic  for  the  preservation  of  meat,  fish,  milk,  and 
other  food.     Another  substance  termed  Glacudin  has 


iS2  Food  in  Health.  [Parti. 

been  recommended  for  the  same  purpose  ;  this  consists 
of  borax,  boric  acid,  sugar  and  glycerine. 

Much  discussion  has  taken  place,  especially  on 
the  Continent,  as  to  the  propriety  of  allowing  salicylic 
acid  to  be  used  for  the  preservation  of  wine,  beer, 
milk,  fish,  meat,  fruit  and  other  food  substances  ;  and 
the  decision  has  been  almost  universally  against  its  use 
as  being  distinctly  injurious  to  the  healthy  organism. 

In  addition  to  the  preceding  yenera^  account  of  the 
different  methods  of  preserving  foods,  it  may  be  useful 
to  describe  the  measures  usually  adopted  for  preserving 
particular  important  articles  of  diet. 

Milk  may  be  preserved  by  various  means.  1.  It 
may  be  boiled,  then  placed  in  a  V^ottle  which  should 
be  completely  filled  and  at  once  corked  up  and  sealed 
.so  as  to  be  air-tight.  The  milk  lessens  in  bulk,  a 
vacuum  is  formed  on  its  sui'face,  and  in  this  way  it  will 
keej)  for  some  time.  It  will  keep  longer  if  a  little 
sugar  be  added.  If  it  is  heated  in  a  close  vessel  to 
250°  F.,  it  will  keep  for  years.  The  butter  may,  how- 
ever, separate.  2.  The  passing  of  sulphurous  acid 
gas  through  milk  after  boiling,  or  the  addition  of 
sodium  sulphite  to  it,  will  preserve  it  for  some  time. 
3.  The  addition  of  a  little  carbonate  of  soda  and 
sugar,  with  or  without  boiling,  will  keep  it  for  ten  or 
twelve  days.  4.  The  addition  of  boric  acid  and  the 
other  antiseptics  already  mentioned.  The  method  of 
preserving  concentrated  milk  in  tins  has  been  de- 
scribed. Desiccated  or  dried  milk  is  milk  mixed  with 
a  little  sugar  and  dried  at  a  low  temperature.  It 
is  said  to  form  an  excellent  milk  when  dissolved 
in  water. 

Butter. — The  tendency  of  butter  to  become 
raiicid,  especially  in  hot  weather,  is  well  known.  This 
is  due  to  the  presence  of  some  of  the  albuminous 
constituents  of  the  milk,  which,  acting  as  a  ferment, 
cause  the  setting  free  of  the  fatty  acids.  Washing 
the  butter  thoroughly,  so  as  to  separate  these  sub- 
stances completely,  contributes  greatly  to  its  subsequent 
preservation.     Indeed,  it  may  be  preserved  for  some 


Chap.  VII.]  Preservation  of  Food.  183 

time,  but  at  the  cost  of  some  loss  of  flavour,  by 
melting  and  shaking  with  boiling  water  so  as  com- 
pletely to  remove  these  substances.  Butter  also  that 
has  become  rancid  may  be  again  rendered  eatable  by 
melting  and  agitating  it  repeatedly  with  boiling  wat^r, 
which  removes  the  fatty  acids;  while  melted  it 
should  be  poured  into  ice-cold  water.  Salt  is  used 
very  largely  in  the  preservation  of  butter ;  it  checks 
the  decomposition  of  the  casein  which  is  present  and 
so  preserves  the  butter  from  decay.  Sugar  will  also 
exert  the  same  influence,  and  butter  immersed  in 
syrup  is  said  to  keep  even  better  than  when  salted. 
Butter  may  also  be  preserved  by  excluding  it  from  air, 
so  that  merely  immersing  it  in  cold  water,  which 
should  be  changed  daily,  will  keep  it  fresh  for  a  week 
or  more.  It  is  said  that  a  weak  solution  of  tartaric 
acid  or  water  acidulated  with  acetic  acid  (3  grammes 
to  a  litre)  is  far  more  eflicacious,  and  that  butter  has 
been  kept  fresh  for  two  months  by  its  means  at 
a  temperature  of  60°  to  68°.  It  should  be  kept  in  a 
closely-covered  vessel. 

Potatoes. — According  to  Parkes,  sugar,  in  the 
form  of  molasses,  is  the  Vjest  substance  for  preserving 
potatoes  on  a  large  scale ;  a  cask  is  filled  with  alternate 
strata  of  molasses  and  peeled  and  sliced  potatoes.  On 
a  small  scale,  boiling  the  potatoes  for  a  few  minutes 
will  keep  them  for  some  time.  Free  exposure  to  air, 
turning  the  potatoes  over  and  at  once  removing  those 
that  are  bad,  are  useful  plans.  Preserved  potatoes 
have  already  been  described, 

LicbiK's  Exti'a<-t  is  a  fonn  of  lyreserved  and 
condensed  meat. 

It  is  prepared  by  subjecting  meat  entirely  freed 
from  tendons  and  fat  to  a  moderate  heat  for  some 
time  until  a  viscid  dark  extract  is  obtained  which 
contains  the  salts,  creatin,  and  other  organic  nitro- 
genous substances.  Mixed  with  warm  water,  it 
forms  a  nutritious  and  palatable  fluid.  One  pound  of 
mutton  gives  about  two-fifths  of  an  ounce  of  extract. 
It  has  no  tendency  to  decomposition  and  will  keep 


184  Food  in  Health.  [Pan  i. 

unaltered  for  years.  Other  extracts  of  meat  resemble 
it  more  or  less  in  composition. 

Liebig's  extract  has  been  found  remarkably 
restorative  after  the  fatigue  of  great  exertion  and  to 
increase  cardiac  power.  It  has  been  used  with  great 
effect  mixed  with  wine  to  rouse  wounded  soldiers  who 
have  passed  into  a  state  of  collapse.  It  does  not, 
however,  represent  a  true  nutritive  albuminate,  as 
it  contains  no  albumen  or  fibrin,  its  nitrogenous 
constituents  being  in  the  form  of  creatin  and  soluble 
extractives.  It  is  believed  to  increase  the  power  of 
the  stomach  to  digest  vegetable  food,  and  while  not 
capable  of  acting  as  a  substitute  for  meat,  yet  assists 
also  in  digesting  meat  so  that  less  meat  is  needed.  It 
should  not  be  taken  in  large  quantities,  as  it  has  been 
known  to  cause  heaviness  and  torpor,  probably  owing 
to  the  excess  of  nitrogenous  extractives  introduced 
into  the  system.  It  is  a  useful  addition  to  poor 
soup.  A  great  number  of  condensed  fluid  meat 
extracts  are  prepared,  most  of  which  are  of  value  as 
nutritious  restoratives,  but  none  of  them  can  be  said 
to  be  capable  of  completely  taking  the  place  of  meat. 

Meat  biscuits  can  be  made  in  a  very  simple  way 
(Parkes)  "  by  mixing  together,  cooking  and  baking 
1  lb.  flour,  1  lb.  meat,  -^  lb.  suet,  |  lb.  potatoes,  with  a 
little  sugar,  onion,  salt,  pe|>per,  and  spices.  A  palatable 
meat  biscuit,  weighing  about  1^  lb.,  containing  10  to 
12  per  cent,  of  water,  is  thus  obtained,  whicli  keeps 
quite  unchanged  for  four  months." 

The  celebrated  Erhsivurst,  or  pea  sausage,  of  the 
German  army  contains  pea- flour  and  fat  poik,  with 
some  salt.  It  is  ready  cooked  and  can  be  quickly 
made  into  a  soup.  It  was  used  largely  in  the  Franco- 
German  war,  and  was  much  liked  for  a  few  days, 
but  it  is  said  the  men  got  e\'entual]y  tired  of  it,  and 
that  in  some  it  produced  flatulence  and  diarrhoea ; 
but  it  is  obvious  that  however  useful  such  a  form  of 
preserved  food  might  be,  it  is  one  which  should  be 
varied  with  other  foods,  and  not  trusted  to  exclusively, 
or  for  long  at  a  time. 


185 


CHAPTER    VIIL 

THE    SCIENTIFIC   BASIS    OP    DIETARIES   AND    RATIONS. 

The  object  of  food  is,  as  we  have  .'^een,  to  repair  the 
waste,  and  to  administer  to  the  growtli  of  the  bodily 
organs:  to  maintain  a  nutritive  equilibrium  between 
the  bodily  income  and  expenditure  under  all  the 
varying  conditions  and  circumstances  to  which  the 
human  organism  may  be  exposed  ;  to  maintain  all 
the  functions  of  the  body  in  healthy  activity,  and  to 
prevent  any  loss  of  the  normal  body-weight.  In  the 
determination  of  a  dietary  or  dietaries  adequate  to 
all  the.se  purposes,  in  the  selection  of  suitable  kinds 
and  sufficient,  but  not  excessive,  amounts  of  food, 
experience  has  shown  that  it  is  not  altogether  safe  to 
trust  merely  to  the  sensation  of  hunger  or  to  the 
voluntary  choice  or  desires  of  individuals.  Such  a 
reliance  might  lead  to  injurious  over-indulgence  on 
the  one  hand,  and  serijus  insufficiency  on  the  other. 
It  is  therefore  necessary  that  we  should  be  provided 
with  some  accurate  scientifi  j  data,  which  shall  furnish 
a  secure  basis  for  the  construction  of  the  various  diet 
scales  and  rations  appropriate  to  the  many  varying 
periods  and  conditions  of  human  life. 

The  ])ractical  considerations  associated  with  this 
investigation  are  of  tlie  greatest  general  importance 
and  interest,  for  they  include  the  determination  of 
such  questions  as  the  food  of  the  soldier  at  home  and 
in  the  field  ;  the  food  of  convicts  in  strict  confinement 
and  engaged  in  hard  labour ;  of  the  inhabitants  of 
various  public  institution.s,  such  as  schools,  asylums, 
hospitals,  etc.  ;  the  appropriate  food  in  childhood, 
growing  youth,  and  maturity  in  the  different  sexes ; 


1 86  Food  in  Health.  [Pani. 

in  sickness  and  in  health ;  in  different  occupations, 
climates,  etc. 

A  certain  amount  of  valuable  information  can 
undoubtedly  be  obtained  by  reference  to  the  long- 
established  customs  and  habits  of  different  classes  of 
persons  as  founded  on  the  teachings  of  a  lengthened 
experience ;  but  it  is  an  advantage  to  be  able  to  bring 
to  the  support  of  the  conclusions  founded  on  such 
data  more  precise  experimental  proof.  To  provide 
this  is  admittedly  a  difficult  and  complex  problem. 

The  elaborate  series  of  experiments  undertaken  by 
Voit  and  Pettenkofer  had  for  their  object  the  estima- 
tion of  the  influence  which  various  foods  or  mixtures 
of  foods  had  on  metabolism.  To  do  this  it  was 
needful  to  ascertain  accurately  the  total  bodily  income 
and  output,  so  as  to  discover  under  what  circum- 
stances a  given  amount  of  food  either  exactly  main- 
tained the  nutritive  equilibrium,  and  therefore  the 
body- weight,  or  was  attended  with  either  loss  or 
gain. 

By  this  means  these  observers  were  enabled  to 
determine,  with  precision,  the  amount  of  the  three 
chief  cla.sses  of  alimentary  substances — the  albuminates, 
fats,  and  carbo-hydrates,  which  were  respectively 
necessary  to  satisfy  the  wants  of  the  organism,  and 
also  to  ascertain  what  was  the  fate  of  any  excess 
of  these. 

One  fact,  as  might  have  been  expected,  soon 
became  evident,  viz.  that  the  amount  of  alimentary 
substances  consumed  in  the  body,  even  under  ordinary 
conditions,  was  very  variable,  and  depended  on  the 
general  nutritive  condition  of  the  body,  on  the 
amount  of  work  performed,  and  on  certain  external 
circumstances ;  so  that  in  order  to  estimate  the 
amount  of  food  needed  by  different  persons,  it  became 
necessary  to  take  the  averages  of  a  great  number  of 
experiments  adapted  to  the  experience  of  oxxlinary 
daily  life,  aa  well  as  to  special  conditions. 

It  was  found  that  the  two  most  important  factors 
which  determined  the  amount  of  food    required    by 


Chap.  VIII.] 


Dietary  Experiments. 


187 


diflferent  persons  were  :  first,  physical  development 
and  body-weight;  and  second,  the  amount  of  work 
perfoi-med.  In  short,  as  might  readily  be  supposed, 
a  strong,  well-developed  man  in  active  work  required 
much  more  food  than  a  small  feebly-developed  man 
leading  an  idle  life. 

The  three  following  tables  are  abstracted  from 
those  given  by  Bauer  as  representing  the  results  of 
Pettenkofer's  and  Voit's  experiments  to  show  the 
daily  incoming  and  outgoing  in  the  case  of  a  powerful 
man  weighing  69-5  kilos.  (1)  in  a  state  of  rest ;  and  (2) 
during  work  ;  and  (3)  for  purposes  of  comparison  in 
a  small  and  ill-nourished  man  with  a  liberal  diet 
during  rest. 


1.  Income    and  Output  with  an  Abundant  Diet  during 
Rest.* 


Income. 


Meat 

White  of  Egg 
Bread  ... 

MHk 

Beer 

Suet     

Butter... 
Starch... 

Sugar  

Salt      

Water ... 
Oxygen  from  Air 

Total       ... 


139-7  gr 

ammes. 

41-5 

>> 

450-0 

» 

500-0 

yy 

IO'25-O 

n 

700 

» 

30-0 

n 

70-0 

n 

17-0 

n 

4-2 

>t 

286-3 

n 

709-0 

n 

3342-7 


Urine  . 
Fceces . 
Breath 


Output. 


1243-1  grammes. 

114-5 
1739-7 


3197-3 
Balance    +     145-4 


•  Baaer,  "Dietary  of  tbe  Sick."  It  has  not  been  thought  neces- 
sary to  reproduce  all  tbe  details  of  the  chemical  analysis  of  the 
various  foods  consuineiL 


[88 


Food  in  Health. 


[Parti. 


In  this  experiment  a  summary  of  the  results  of 
chemical  analysis  gives  the  following  figures  : — 


Taken  in. 

Con.snmed. 

Stored  up. 

Albumen 

137 

137 

Fat     

117 

52 

65 

Carbo-hydrafos 

352 

352 

— 

2.     Income 

AND    Output    with 

AN      AllUXD.ANT      DiKT 

DUllIXG    WoKK. 

Income. 

Meat    . . . 

151-3  erammea. 

White  of 

Egg            

48-1  " 

Bread  ... 

450-0 

Milk    ... 

500-0 

Beer    , . . 

1()G5-!) 

Suet     ... 

60-2 

Butter... 

30-0 

Starch... 

70-0 

Sugar . . . 

17-0 

Salt     ... 

4-9 

Water... 

489-1 

Oxygen  from  Aii 

1006-1 

Total 


Urine  ... 
Faeces ... 
Respiration 


Output. 


Balance 


3892-6 


1261- 1  grammes. 
1290         „ 
2545-6 


3935 -G 
-     43-0 


It  was  found  on  chemical  analysis  that  during 
hard  work  whereas  only  the  srtine  quantity  of  albumen 
(137  grammes)  was  consumed  as  during  rest,  on  the 
other  hand,  173  grammes  of  fat  were  consumed,  as 
compared  with  52  during  rest.  The  amount  of 
carbo-hydrates  was  the  same  in  both  instances — 352 
grammes. 


Chap.  VIII.] 


Dietary  Experiments. 


Incuhe  and   OuTi'tT  IN   A  Small   Ill-nourisheu 

WITH    AK    AliUNDANT   DiET    DUEING    ReST. 


189 

Man, 


Income, 


Meat 

White  of  Egg 

Bread 

Milk 

Beer , 

Suet 

Butter... 

Starch 

Sugar  

Salt      

Water 

Oxygen  from  the  Air 

Total       


Out]  mi 


Urine  ... 
Faeces  .. 
Respiration 


151-1  gi- 

amines, 

61-8 

4500 

509-6 

1012-7 

58-8 

30-0 

70-0 

17-0 

4-3 

41-4 

600-7 

3007-4 


1069-6  grammes. 
137-1        „ 
1597-8 


2804-5 
Balance     -(-     2029 


As  the  result  of  these  experiments,  Voit  fixed  for 
the  average  daily  needs  of  a  moderate  worker  118 
grammes  of  albumen  (nitrogen  18-3  and  carbon  63)  and 
265  grammes  of  carbon,  either  in  the  form  of  fats  or 
carbo-hydrates,  makingatotalof  328 grammes  of  carbon. 

The  estimate  given  by  Dujai-din-Beaumetz*  agi-ees 

*  Accortliiig  to  Dujardin-Boauiiictz,  a  man  loses,  in  connection 
with  the  processes  of  nutrition,  nitrogen,  carbon,  water,  and  salts. 
In  twenty-four  hours  these  losses,  on  an  averaije,  amount  to  20 
grammes  (300  grains)  of  nitrogen,  310  gi-ammes  (4,6.50)  grains  of 
carbon,  30  gi-annues  (450  grains')  of  salts,  and  3  litres  (about  6 
pints)  of  water.  The  chief  i)art  of  ti'.e  nitrogen  (14-5  grammes) 
passes  away  in  the  urine  in  the  form  of  urea  and  uric  acid,  and 
the  remainder  (5-5  grammes)  in  tlie  fa;ces,  i)erspLration,  and 
mucous  discliarges.  Of  the  carbon,  200  grammes  are  consumed  in 
the  lungs,  45  grammes  are  ehminated  by  the  kidneys,  and  15 
grammes  in  the  other  secretions.  The  water  passes  off  by  the 
skin,  lungs,  kidneys,  and  bowel.i.  A  man's  food  must  contam  the 
elements  necessary  to  repair  these  incessant  losses. — "  L'Hygiene 
Alimentaire. " 


190 


Food  in  Health. 


[Part  I. 


closely  with  this :  "  An  adult  man  submitted  to 
moderate  labour  loses  20  grammes  of  nitrogen  daily, 
and  300  grammes  of  carbon ;  these  20  grammes  of 
nitrogen  represent  124  grammes  of  dry  proteid  matters, 
and  as  these  contain  64  gi'ammes  of  carbon,  on  sub- 
tracting these  64  grammes  from  the  300  grammes  neces- 
sary for  nutrition,  there  remain  236  grammes  of  carbon 
to  be  derived  from  starch  substances  or  from  fats." 

Moleschott's  estimate  is,  for  an  adult  working  man, 
130  grammes  of  albumen,  84  grammes  of  fat,  404 
gi'ammes  of  carbo-hydrates,  and  30  grammes  of 
salts. 

The  following  table  by  Forster  gives  the  analysis 
of  the  habitual  diets  of  several  persons  of  diflferent 
occupation,  with  the  relative  amounts  of  nitrogen  and 
carbon  in  each  : — 


Albumen. 

Fat. 

Carbo- 
hydrates. 

Nitrogen. 

C.irbon. 

Labourer,  age  36 

133 

95 

422 

21 

321 

Joiner     

131 

68 

494 

20 

342 

Young  Surgeon. . . 

127 

89 

362 

20 

297 

„            „ 

134 

102 

292 

21 

280 

Powerful  old  Man 

116 

68 

345 

— 

— 

Landois  ("  Text-book  of  Human  Physiology  ")  thus 
analyses  the  average  income  and  expenditure  of  an 
adult  doing  a  moderate  amount  of  work  : — 


Incomb. 


C, 

H. 

N. 

0. 

Albumen,  120  gi-ammes  =: 
Fats,            90        „          = 
Stai-ch,       330        „         = 

64-18 

70-20 

146-82 

8-60 
10-26 
20-33 

18-88 

28-34 

9-54 

162-85 

281-20 

39-19 

18-88 

200-73 

Chap.  VI J i.]    Bodily  Income  AND  Output. 


191 


To  thi.-!  should  be  added : 


In.  Air  respired 

Water 

Salts 


744- 11  grains  of  oxygen. 
28180        „  „ 

32-0 


The  whole  is  equal  to  3^  kilos.  =  7  lb.,   i.e.  about 
g-^iyth  of  the  body-weight. 


Output  ou  ExPENUixuaE. 

Water. 

Carbon. 

H. 

N.            0. 

By  Respiration       .  . 
,,  Perspiration 

„  Urine     

„  Faeces     

330 

660 

1700 

12s 

248-8 

2-6 

9-8 

20-0 

3-3 
3-0 

?      :  631-1.5 
—     '       7-2 
15-8    1     11-1 
3-0    !     12-0 

2818 

281-2 

6-3 

18  8    !  661-4.5 

To  this  is  to  be  added :  298  grammes  of  water  formed  in 
the  body  by  the  oxidation  of  hydrogen.  These  298  grammes 
of  water  =:  34-59  H.  and  26341  0.  26  gi-ammes  of  salts  are 
given  off  in  the  urine,  emd  6  by  the  faeces. 

So  that  about  6  per  cent,  of  the  water,  about 
6  per  cent,  of  the  fat,  and  about  1  per  cent,  of 
the  albumen,  and  about  0-4  per  cent,  of  the  salt8 
of  the  body,  are  daily  transformed  within  the  or- 
ganism. 

At  the  time  when  it  was  believed  tliat  the 
amount  of  mechanical  work  pei-formed  by  the  organ- 
ism required  the  consumj)tion  of  a  corresponding 
amount  of  albuminates,  a  due  supply  of  albumen 
was  regarded  as  of  the  first  importance  in  enabling 
the  body  to  develop  functional  activity  or  muscular 
force ;  and  it  was  a  matter  of  common  observation 
that  persons  who  were  habitually  called  upon  for 
great  exertion  were  accustomed  to  take  large  quanti- 
ties of  albuminous  food.  But  since  it  has  been 
established  that  the  most  strenuous  muscular  labour 


192 


Food  in  Health. 


[Parti. 


does  not  increase  in  the  smallest  degree  the  meta- 
bolism of  albuminates  in  the  body,  we  know  that  it  is 
the  non  nitrogenous  alimentary  principles — the  fats  and 
the  carbo-hydrates — whose  consumption  is  increased 
by  muscular  activity.  This  conclusion  is  not,  how- 
ever, inconsistent  with  the  common  observation  that 
during  active  exertion  the  body  requires  a  more 
liberal  supply  of  albumen  than  when  at  rest,  for  in 
order  to  perform  sustained  and  laborious  physical 
efforts  it  is  necessary  to  have  well-developed  and 
well-nourished  muscles,  which  means  the  existence  in 
the  body  of  a  large  proportion  of  nitrogenous  tissue, 
for  the  maintenance  of  which  a  corresponding  pro- 
portion of  albuminous  food  is  needed.  But  a  physic- 
ally weak  person  will  not  be  enabled  to  perform  an 
increased  amount  of  muscular  work  simply  by  sup- 
plying him  with  a  larger  amount  of  albumen  in 
his  food.  It  would  be  necessary,  in  the  fii'st  place, 
to  produce  an  increased  muscular  development  by 
raising  his  nutrition  to  a  higher  standard.  Life  can, 
no  doubt,  in  certain  circumstances,  be  maintained 
on  a  much  smaller  amount  of  food  than  an  active 
labouring  man  requires,  as  is  exemplified  in  the  so- 
called  "  subsistence  diet  "  of  Playfair.  The  annexed 
table  gives  (in  grammes)  the  amounts  of  the  different 
classes  of  food,  together  with  the  relative  proportions 
of  carbon  in  each,  required,  accoi'ding  to  Playfair,  for 
mere  subsistence,  as  well  as  in  varying  circumstances 
of  muscular  effort : — 


Albu- 
men. 

Fat. 

Carbo- 
hydrates. 

Carbou 

Minimum  ("snbsistenco")  diet 

Rest 

M  oderate  exercise     

Hard  work 

Intense  exertion        

57 

71 

119 

156 

184 

14 
28 
51 
71 
71 

340 
340 
530 
567 
567 

190 
210 
337 
380 
405 

Chap.  VHi.]       Standard  Daily  Diets. 


193 


Voit  has  expressed  surprise  at  Playfair's  estimates 
of  the  quantity  of  albumen  (57  and  71  grammes) 
in  the  lirst  two  cases,  and  he  considers  them  far 
too  low,  unless  for  individuals  of  unusually  small 
physique. 

Parkes  also  points  out,  with  regard  to  the  sub- 
sistence diet  of  Playfair,  that,  while  calculated  as 
sufficient  for  the  internal  mechanical  work  of  the 
body,  it  may  be  doubted  if  an  average  man  could 
exist  on  it  without  losing  weight,  as  it  supposes 
absolute  repose;  and  he  regards  the  "rest"  diet  as 
probably  the  minimum  for  an  adult  male  of  average 
size  and  weight  (150  lb.  =  67  kilos). 

Comparing  the  estimates  of  various  authorities, 
Parkes  has  drawn  up  the  following  table  of 


Standard  Daily  Diets  for  a  ]\Ian  in  Ordinary  Work. 


Moleschott. 

Petteiikofcr 
and  Voit. 

Ranke. 

Means. 

oz.  av.  gi-ms. 

oz.  av. 

grins. 

137 

117 

352 

30 

630 

oz.  av. 

grins. 

02.  av. 

grma. 

Proteids     ... 

Fats 

Carbo-hydrates 
Salts 

4-50 

2-90 

14-26 

1-06 

130 
84 

404 
30 

4-83 

4-12 

12-40 

1-00 

2-2 -41 

3-52 
3-52 
8-4l> 
0-81) 

16-39 

100 

100 

240 

2o 

465 

4-31 
3-53 
11-71 
100 

1-22 

100 

332 

28 

Total   water- ■) 
free  food  ...j 

22-87 

648 

20-55 

582 

If  we  compare  these  with  Playfair's  diets,  we 
notice  a  great  discrepancy  in  the  estimation  of  the 
requisite  amount  of  fats.  Piither  Playfair's  must  be 
defective,  or  the  others  excessive  in  this  alimentary 
principle.  It  is  true  that  in  the  working  diets  of 
Playfair  the  deficiency  in  fats  is  attempted  to  be 
compensated  for  by  an  excess  of  carbo-hydrates ;  but 
it  is  doubtful  if  the  carbo-hydrates  can  advantageously 
take  the  place  of  fats  to  this  ext'^nt  in  ordinary 
diets. 

The  constituents  of  the  above  diets  are  estimated 
as  absolutely  water-free  ;  so  that,  assuming  the  water 
N 


194  Food  in  Health.  [Pan  i. 

free  food  to  be  23  oz.,  and  a  man's  weight  to  be 
1501b.,  each  pound-weight  of  the  body  receives  in 
twenty-four  hours  0'15  oz.,  or  the  whole  body  re- 
ceives nearly  one-hundredth  part  of  its  own  weight. 
But  ordinary  solid  food  contains  usually  between  50 
and  60  per  cent,  of  water ;  and  if  we  add  this  to  the 
water-free  solids,  the  total  daily  amount  of  so-called 
dry  food  (exclusive  of  liquids)  is  about  48  to  60  oz. 
But  from  50  to  80  oz.  of  water  in  the  liquid  form  is 
usually  taken  in  addition,  and  this  would  make  the 
total  supply  of  water  =  70  to  90  oz.,  or  half  an  ounce 
for  each  pound  of  body-weight. 

Allowing  for  the  modifying  influence  of  varying 
conditions,  we  may  fix  the  usual  average  daily  range 
in  different  males  as  from  40  to  60  oz.  of  ordinary 
solid  food,  and  from  50  to  60  oz.  of  water.  Under 
great  exertion  men  require  an  increased  amount  of 
food,  especially  in  the  form  of  albuminates  and  fats, 
and  a  total  of  66  to  77  oz.  of  solid  food  (1-970 
to  2*180  grammes)  may  be  estimated  as  an  average 
requirement  under  such  circumstances. 

Average  Daily  Water-free  Diet  required  for  an  Adult 
Man  in  very  laborious  Work  (Farkes). 


Proteids  ...       60  to    7  0  oz.  or  170  to  198  grammes. 

Fats       3-5  „     4-.5  „     „     99  ,,   128         „ 

Carbo-hydrates  IGO  „  180  „     „  454  „  510         „ 

Salts       1-2  „     1-5  „     „     34  „     43 


Total  water-free  Food  26-7  „  31-0  „     „  767  „  879 


The  following  table  (from  Parkes)  may  be  used  as 
♦*  an  approximate  basis  for  the  calculation  of  diets 
according  to  size  and  work  "  : — 


Chap. VIII.]    Table  for  Calculating  Diets.      195 


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196 


Food  in  Health. 


[Part  I. 


Beyond    300   fooUons  (or    100,000  Icilogramme- 
metres)  the  additions  would  require  to  be  greater. 


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Chap.  VIII.]    Tables  for  Calculating  Diets.     197 


The  following  is  another  useful  table  (from  Parkes 
also),  "  compiled  from,  in  most  cases,  several  analyses 
by  different  authors,"  for  calculaling  diets.  From 
such  tables  of  mean  composition  the  four  classes  of 
alimentary  principles  in  any  diet,  the  articles  of  which 
are  known,  may  be  calculated.  Such  tables  are,  of 
course,  merely  approximative  ;  "  they  are  very  useful 
as  giving  a  general  idea  of  diet,  althougli  they  are  not 
accurate  enough  to  be  used  in  physiological  inquiries." 


[u  100  pa 

•ts. 

Articles. 

Allm- 

Car- 

Watti'.l  mill- 

Fats. 

bo-liy- 

SaltH. 

ates). 

drates. 

Meat  of  best  quality,  witli 
little  fat,  like  Beef-stcakf 

1     74-4 

20-5 

3-5 

— 

1-6 

Uncooked  Meat  of  the  kinc 

J 

supplied  to  soldiers.  Bee: 

70 

15 

8-4. 

— 

1-6 

and  Mutton      

) 

Uncooked  Meat  of  fattenec 

j 

cattle,    calculated   from 

Lawes'  and  Gilbert's  ex- 
periments.   These  num- 

[   6. 

i 

14 

19 

— 

3-7 

bers  are  to  be  used  if  the 

meat  is  very  fat 

) 

Cooked  Sleat,  roast,no  drip- 

1 

ping  being  lost.    Boilec 

j. 

27-6 

lo-45 



2-95 

assumed  to  be  the  same 

Corned  Beef  (Chicago)    .. 

62 -2 

23-3 

U 

— 

4 

Salt  Beef  (Giiardiu) 

49-1 

29-6 

0-2 

— 

21-1 

Salt  Pork 

44-1 

26-1 

7-0 

— 

22-8 

Fat  Pork  (Letheby) 

39-0 

9-8 

48-9 

— 

2-3 

Dried  Bacon     ,, 

1  .J  0 

8-8 

73-3 

2-9 

.Smoked  Ham  (Kcinig)    .. 

27-8 

24-0 

36 -.3 

— 

lO-l 

Horseflesh              „ 

74-3    21-7 

2-6 

— 

1-0 

White  Fish  (Letheby)    .. 

78-0  ,  18-1 

2-9 

— 

1-0 

Poultry      

74  0 

21-0 

3-8 

— 

1-2 

Bread,  White  AVhcatcn,  0 

■'•    40 

8 

l-o 

49  2 

1-3 

average  quality 

1 

Wheat  Flour,  of  average 
quality  ... 

1- 

11 

2 

71-2 

0-8 

Biscuit      

80    15-6 

1-3 

73  4 

1-7 

Rice           .„         

10-0 

5  0 

0-8 

83-2 

0-6 

198 


Food  in  Health. 


[Part  I. 


In  100  parts. 

Articles. 

Albu- 

Car- 

Water. 

min- 
ates. 

Fats. 

bo-hy- 
drates. 

Salts. 

Oatmeal  ( Letheby ) 

150 

12-6 

6-6 

63-0 

3-0 

Maize  (Po<?giali),  cellulose 
excluded           } 

13-5 

100 

6-7 

64-5 

1-4 

Macaroni  (Konig) 

13-1 

9-0 

0-3 

76-8 

0-8 

Millet    (Kcinig),    cellulose  ^ 
excluded           j 

12-3 

11-3 

3-6 

67-3 

2-3 

Arrowroot 

15-4 

0-8 

— 

833 

0-27 

Peas  (dry) 

150 

22-0 

2-0 

53-0 

2-4 

Potatoes    ... 

74-0 

2-0 

0-16 

21-0 

1-0 

Carrot.s  ( cellulose  ex cl uded ) 

8.5  0 

1-6 

0-25 

8-4 

1-0 

Cabbage     

91-0 

1-8 

0-50 

5-8 

0-7 

Butter  (Bell)         

7-5 

10 

90-5 

— 

1-0 

Egg  ( 1 0  per  cent,  must  be  \ 

deducted  for  shell  from  > 

73-0    13-5 

11-6 

— 

1-0 

weight  of  Egg)             ...  ) 

1 

Cheese  (Single  Glo'ster)... 

36-0  ;  31-0 

28-5 

— 

4o 

Milk  (sp.  gr.  1  029  and  over) 

86-8      4-0 

37 

4-8 

0-7 

Cream  (Letheby)  ... 

66  0      2-7 

26-7 

2-8 

1-8 

Skimmed  Milk  (Letheby) 

88-0      4-0 

1-8 

5-4 

08 

Sugar         

3-C      — 

— 

96  0 

O'o 

Pemmican  (Uo  Chaumont) 

7-2    35-4 

65-2 

— 

1-8 

The  gelatin  of  meat  is  reckoned  with  the  albumin- 
ates. It  is  not  certain  what  deduction  should  be  made 
on  account  of  its  lower  nutritive  value,  which  is  about 
one-fourth  that  of  albumen,  according  to  Bischoff. 

"  The  mode  of  using  the  above  table  is  very 
simple.  The  quantity  of  uncooked  meat  or  bread 
being  known,  and  it  being  assumed  or  proved  that 
there  is  no  loss  in  cooking,  a  rule  of  three  bring.s  out 
at  once  the  proportions.  Thiis,  the  ration  allowance 
of  meat  for  soldiers  being  12  oz.,  2*4  oz,,  or  20  per 
cent.,  is  deducted  for  bone,  as  the  soldier  does  not  get 
the  best  parts.  The  quantity  of  water  in  the  remain- 
ing 9-6  oz.  will  be  75  ^^'^=  72,  and  the  water-free 


Chap.  VIII.]    Tables  for  Calculating  Diets.    199 

solids   will    be    2*4  oz.      The   albuminates    will    be 
1"44  oz.,  the  fats  •8064  oz.,  and  the  salts  -ISSG  oz. 
{Parkes^ 

It  is  diflBcult  to  estimate  the  value  of  salt  beef  and 
pork,  as  much  of  the  nutritive  matters  passes  out  into 
the  brine.  This  has  been  estimated  at  as  much  as 
from  one-third  to  one-half.  It  appears  that  myosin 
is  soluble  in  a  10  per  cent,  solution  of  chloride  of 
sodium  ;  therefore  a  large  proportion  of  this  substance 
necessarily  passes  into  the  brine.  "  Analyses  show, 
it  is  true,  a  large  percentage  of  fibrous  and  cellular 
tissue  in  salt  meat,  but  this  is  made  up  of  indigestible 
nitrogenous  substances,  which  afford,  probably,  little 
real  nutritive  material.  Perhaps  salt  beef  may  be 
reckoned  as  equal  to  two-thirds  the  quantity  of  fresh 
beef;  this  estimate  is  certainly  quite  high  enough." 
(Parses.) 

If  we  again  refer  to  the  table  of  "  standard  daily 
diets  "we  shall  be  able  to  ascertain  the  relative  pro- 
portion of  the  nitrogenous  to  the  non-nitrogenous 
substances  in  them ;  it  will  be  found  to  be  about 
1  part  of  nitrogenous  to  3 1  to  4  of  non-nitrogenous 
substances,  e.g.  ; — 


Moleschott. 

Pettenkofer 
and  Voit. 

Eanke. 

Mean. 

Proteids 

Fats        

Carbo-hydrates  ... 
Salts        

100 
65 

315 
23 

100 

87 

258 

22 

100 

100 

240 

25 

100 
84 

271 
23 

If  it  is  required,  as  may  sometimes  be  the  case,  to 
calculate  the  amount  of  nitrogen  and  carbon,  as  well 
as  that  of  hydrogen  and  oxygen  in  the  constituents 
of  any  diet,  Parkes  gives  two  methods  by  which  this 
may  be  done. 

"  1.  Calculate  out  the  dry  albuminates,  fat,  and 


200 


Food  in  Health. 


(Parti. 


carbo  hydrates  in  ounces,  and  then  use  the  following 
table  : — 


Water-free  Coustitueuts. 

Nitro- 
gen. 

Carbon. 

Hyd(r,- 

Sulphur 

grains. 

grains. 

grains. 

grains. 

Proteids             1  02. 

contains... 

70 

212 

8 

6 

Fat 

— 

336 

48 

— 

Carbo-hydrates 

(a)  Starch            „ 

»» 

— 

194 

— 

— 

{fi)  Cane  Suirar    „ 

— 

184 

— 

— 

..    f    Lactin    \ 
^"^    \   Glucose  )  " 

» 

— 

175 

— 

— 

"The  total  amount  of  carbon  in  one  ounce  of 
proteids  is  233  grains,  but  of  this  30  grains  are  con- 
verted into  urea,  and  are  thei-efore  oxidised  only  as 
far  as  carbon  monoxide;  making  allowance  for  this, 
we  have  a  net  total  equal  to  212  grains  of  carbon  fully 
oxidised. 

"  2.  In  the  following  table,  the  calculation  of  these 
ingredients  per  ounce  has  been  made  ;  the  substance 
being  supposed  to  be  in  its  natural  state,  and  to  have 
the  composition  already  assigned  to  it  in  the  former 
table  : — 


One  ounce  (=  437'5  grains)  contains  iu  its 
natural  state  in  grains- 

Babstance. 

Water. 

Nitro- 
gen. 

Carbon 
capable 
of  being 
oxidised. 

Hydro- 
gen cai)a- 
ble  of 
being 
oxidised. 

Sulphur 
cajiable 
of  being 
oxidised. 

Salts 

Uncooked    Meat ) 
(Beef)    of    the  [ 
best  quality  ■  •  •  ) 

Uncooked    Meat 
as  supplied  to 
soldiers          ...  ) 

326 
328 

14-3 
10-5 

55 
60 

3-2 
5-2 

1-2 
0-9 

7 
7 

Chap.  VIII. J    Tables  for  Calculating  Diets.    201 


One  ounce 

'=  437'5  LTiiins)  cnnkiiiis  in  its 

natural  statt 

iu  grains 

— 

Substance. 

Carbon 

Hydro- 

Sulpluu- 

Water. 

Nitro- 
gen. 

capable 
of  being 

gen  capa- 
blc  of 

cajiable 
of  being 

Salts 

276 

oxidised. 

being 
oxidised. 

10-2 

oxidised. 

Uncooked       Fat  \ 
Meat  (Beef)  ...  ) 

9-8 

94 

0-8 

16 

Cooked  Meat    ... 

236 

19-3 

110 

9-6 

1-7 

13 

Corned  Beef  (Chi- ^ 
cago) 1 

228 

16-3 

96 

8-6 

1-4 

17 

Salt  Beef 

215 

20-7 

63 

2-5 

1-8 

92 

Salt  Pork 

193 

18-0 

79 

5-4 

1-6 

lOO 

Fat  Pork 

170 

6-9 

185 

24-3 

0-6 

10 

Dried  Bacon     . . . 

G6 

6-2 

265 

39-9 

0-5 

12 

Smoked  Ham   . . . 

122 

16-8 

174 

19-1 

1-4 

44 

Horseflesh 

325 

15-0 

55 

2-9 

1-3 

4 

White  Fish      ... 

341 

12-6 

48 

2  8 

1-1 

4 

Poultry 

321 

14-7 

57 

3-5 

1-3 

5 

Bread     

173 

5-0 

116 

1-3 

0-5 

6 

Wlicat  Flour    ... 

66 

7-7 

166 

1-9 

0-7 

4 

Biscuit 

35 

10-9 

180 

1-8 

0-9 

7 

Rice       

44 

3-5 

175 

0-8 

()-2 

2 

Oatmeal 

66 

8-8 

168 

3-7 

0-8 

13 

Maize     

59 

7-0 

169 

4-0 

0-6 

6 

IVIacaroni 

57 

6-3 

169 

0-9 

O-o 

3 

Millet     

54 

7-9 

166 

2-6 

0-7 

10 

Arrowroot 

67 

0-6 

162 

0-1 

— 



Peas  (dried) 

66 

15-4 

156 

2-8 

1-3 

10 

Potatoes 

324 

1-4 

45 

0-3 

0-1 

4 

Carrots 

372 

1-1 

20 

0-2 

0-1 

4 

Cabbage 

398 

1-3 

17 

0-3 

0-1 

3 

Butter 

33 

0-7 

299 

43-C 

0-1 

4 

Eggs      

322 

9-4 

68 

6-7 

0-8 

4 

Cheese 

157 

21-0 

161 

17-2 

1-9 

20 

Milk      (sp.      gr.  \ 
1-029  and  over)  ) 

380 

2-88 

30 

2-1 

0-2 

3 

Cream    ... 

289 

1-9 

100 

13-0 

0-2 

8 

Skimmed  Milk... 

385 

2-8 

24 

1-2 

0-2 

3 

Sugar     

13 



178 

— 

— 

2 

Pemmican 

31 

24-8 

260 

29-8 

2-1 

8 

It  has  been  stated   that  the  staudai-d  dail}'  diet 
of   an  adult  man  in  ordinary  work   should  contain 


202  Food  in  Health.  [Parti. 

20  grammes  of  nitrogen  and  300  grammes  of  carbon  •, 
this  would  be  equal  to  3086  and  4,629  grains.  In 
order  to  use  the  above  table  Parkes  gives  the  following 
estimate  in  grains, founded  on  Moleschott's  standard: — 

Nitrogen 321  grains. 

Carbon      4,737      „ 

Hydrogen 179      „ 

Sulphur 28      „ 

Salts          464      „ 

Some  range,  however,  is  necessary  to  adapt  a  diet 
to  different  persons  under  varying  circumstances.  For 
adult  men  the  usual  range  is  from  250  to  350  grains 
(17  to  23  grammes)  of  nitrogen,  and  the  extreme 
range  140  (mere  subsistence  estimate  of  Playfair)  to 
600  grains  (very  great  exertion),  or  9  to  3  3  grammes. 

ni-fed    London   needlewoman,    according  to    B.    Smith's    observations, 
had         135  grains  of  nitrogen,  and  3,271  of  carbon- 
Irish  farm  labourers      ...        349  „  ,,  „      6,185  „ 
And  operatives  during) 

Cotton  famine  in  Lan-  >■  180      200       „  „  8,900  to  4,300  „ 

cashire     ) 

Prisoners  on  light  la- )         ooa  a  «ri 

hour  (Wilson)    ...         f        ^^  ••  "  "     *'°^^         •♦ 

Prisoners  on    hard  la- )         okk  k  oon 

bour  (Wilson)    ...  j-         25fi  „  „  „      6,289 

(0)1  this  diet  they  lost  weight.) 

Military  prisoners  with )         „a,  .  _»» 

hard  labour        ...         f        ^'-  •»  »•  "      '*•'"'         •» 

(On  thisdiet  they  also  lost  weight.) 

Military    prisoners    in )         or\n  k  snn 

India ^        JM  „  „  „     6,800         „ 

(These  did  not  lose  weight.) 

The  amounts  of  carbon  range  in  various  diets  from 
about  3,500  to  6,000  grains.  Pettenkofer's  and  Voit's 
observations  on  two  healthy  men,  on  several  occasions, 
in  ordinary  exercise,  showed  a  daily  consumption  of 
1 9  -82  grammes  =  3058  grain.s  of  nitrogen,  and  Parkes's 
experiments  on  four  healthy  average  men  in  common 
work  showed  that  they  could  be  maintained  in  perfect 
health  and  uniform  weight  on  a  daily  allowance  of 
293  to  305  grains  of  nitrogen.     In  the  best  diets  the 


Chap.  VIII.]        Calculation  of  Diets.  203 

proportion  between  the  niti^ogen  and  carbon  is  nitrogen 
1  to  carbon  15. 

Advanced  age  necessitates  a  considerable  reduction 
in  the  amount  of  food  allowed,  for  not  only  are  all  the 
organs,  and  especially  the  voluntary  muscles  (except  in 
certain  exceptional  instances  of  unusually  vigorous  old 
age),  more  or  less  wasted,  but  the  digestive  and  assimi- 
lative functions  are  far  less  active,  and  are  unable 
to  digest  and  utilise  the  same  amount  of  food  as 
formerly. 

In  an  institution  for  the  widows  of  beneficed 
clergymen,  Forster  found  that  a  number  of  old  ladies 
wei'e  content  with  an  average  allowance  of  67  grammes 
of  albumen,  38  of  fat,  and  266  of  carbo-hydrates, 
while  others  required  rather  more — viz.  80  grammes 
of  albumen,  49  of  fat,  and  266  of  carbo-hydrates  ;  but 
both  these  diets  are  much  richer  in  albuminates  and 
fats  than  Playfair's  "  subsistence  diet." 

Dujardin-Beaumetz  regards  the  following  as  a  fair 
basis  for  the  estimation  of  the  average  daily  dietary 
of  an  adult  man  : — 124  grammes  of  allmminates,  430 
grammes  of  carbo-hydrates,  55  grammes  of  fat ;  this 
would  correspond  with  a  bread  and  meat  ration  of — 

819  grammes  (about  28  oz.)  White  Bread. 
259        „        (about    9  oz.)  Meat. 

Economical  reasons  may  occasionally  require  that 
we  should  cut  down  the  dietary  to  the  lowest  level 
compatible  with  the  maintenance  of  healthy  existence  ; 
but  it  is  always  advisable  when  prati  cable  to  allow  a 
certain  excess  over  and  above  the  strict  physiologicaJ 
necessities.  The  effects  of  a  deficient  diet  are  usually 
not  slow  to  make  their  appearance.  They  are — loss  of 
weight ;  a  lowered  capacity  for  exertion  and  functional 
activity  ;  often  an  unhealthy,  cachectic  aspect,  and  a 
diminished  power  of  resistance  to  unfavourable  in- 
fluences, so  that  during  periods  of  famine  or  enforced 
privation  the  rate  of  mortality  rises  enormously.  The 
consequences  of  immoderate  feeding  and  of  habitual 


204  ■  Food  in  Health.  [Pani, 

excess  are  frequently  also  sufficiently  conspicuous.  In 
many  cases  an  unusual,  unequal,  and  unsightly  de- 
position of  fat  takes  place  in  connection  with  the 
abdominal  and  other  organs,  togetlier  with  disturb- 
ances in  the  functions  of  tiie  liver  and  other  organs 
of  digestion.  But  apart  from  the  deposition  of  fat, 
which  is  not  an  invariable  consequence,  excess  of  food 
leads  to  retai'ded  metabolism  and  imperfect  nutritive 
changes,  indicated  sometimes  by  the  presence  of  uric 
acid  deposits,  of  oxalates  in  the  urine,  of  an  excessive 
excretion  of  urea.  The  disturbances  of  metabolism 
which  lead  to  these  deposits  are  as  yet,  however,  only 
imperfectly  understood  ;  but  there  is  a  vast  deal  of 
evidence  which  points  to  immoderate  feeding  as  one 
of  their  common  antecedents. 

Not  only  is  it  important  to  have  due  regard  to 
quantity  in  the  construction  of  dietaries,  but  it  is  also 
equally  necessary  to  have  regard  to  the  proportionate 
coawposition  and  quality  of  foods.  A  jmrticular  food- 
stuff may  contain  all  the  constituents  necessary  for 
the  nutrition  of  the  body,  but  may  yet  be  quite  un- 
suitable to  form  the  sole  food  of  the  oi'ganism,  on 
account  of  the  unfavourable  inoporlions  in  which  they 
may  exist  in  it.  Or  another  food-stuff  may  contain 
some  or  all  of  the  necessary  elements  of  nutrition 
but  they  may  not  all  be  digestible  and  utilisable. 
These  considerations  show  the  necessity  of  mingling 
or  combining  different  articles  of  food  in  due  and 
proper  proportions  in  the  construction  of  diet- 
tables. 

The  following  table,  which  is  modified  from  one  by 
Voit,  shows  in  a  striking  manner  the  unsuitableness 
of  many  common  articles  of  food  to  be  em]jIoyed 
as  the  sole  constituents  of  human  diet,  and  the 
great  wastefulnes.s  on  the  one  hand  a:;d  insufficiency 
on  the  other  which  would  be  involved  in  the  at- 
tempt. 

In  order  to  yield  the  necessary  daily  ration  of 
nitrogen  and  carbon,  the  following  quantities  of  the 
undermentioned    articles    would    be    required ;    for 


Chap.  viiM  Suitability  of  Different  Foods.  205 

"  expei'ience  has  shown  that  the  diet  best  suited 
for  the  l)ody  must  contain  one  part  of  nitrogenous 
foods  to  three  and  a  half  or  at  most  four  and  a  half 
of  the  non-nitrojrenous  "  : — 


To 

To 

jield    18-3 

yield  328 

grainniea 

grammes 

Nitrogen. 

Carbon. 

Cheese 

272 

Bacon 

450 

Peas 

520 

JIaize 

801 

Lean  Meat . . . 

0.38 

Wheat  ilecil 

824 

"Wheat  Flour 

796 

Rice 

896 

Eggs  (18)  ... 

90.') 

Peas 

919 

Maize 

989 

Cheese 

...     1,160 

Black  Bread 

..     1,430 

Black  Bread 

...     1,346 

Rice 

..     l,8f>8 

Egi?s  (43)   ... 

...     2,231 

Milk 

..     2,905 

Lean  iloat . . . 

...     2,620 

Potatoes     , . . 

..     4,576 

Potatoes 

...     3,124 

Bacon 

..     4,796 

Milk 

...     4,652 

Cabbage     . . , 

...     7,625 

Cabbage     ... 

...     9,318 

Turnips 

..     8,714 

Turnips 

...  10,650 

Beer 

..  17,000 

Beer 

...  13,160 

It  would  be  scarcely  possible  for  any  individual  to 
consume  and  digest  daily  2,620  grammes  {i.e.  about 
90  ounces)  of  meat,  the  quantity  necessary  in  order 
to  yield  the  daily  requirement  of  carbon,  while  the 
waste  of  nitrogen  would  be  px'odigious ;  on  the  other 
hand,  it  would  require  4,575  grammes  or  about  10 
lb.  of  potatoes  to  yield  the  daily  requirement  of 
nitrogen.  And  milk,  which  is  the  food  of  Nature's 
own  selection  for  the  infant,  would  be  most  wasteful 
as  the  sole  food  for  the  adult,  as  he  would  require 
4,652  grammes  or  10  pints  to  furnish  the  daily  sup})ly 
of  carbon  he  requires,  and  a  considerable  proportion 
of  the  nitrogen  would  be  wasted.  Whereas  in  a 
mixed  diet  of  meat  and  potatoes,  less  than  538 
grammes  of  the  former  together  with  less  than  3,124 
grammes  of  the  latter  would  yield  respectively  the 
amount  of  nitrogen  and  carbon  required. 

The  carbon  necessary  for  nutrition  can  be  pro- 
vided, as  we  have  seen,  either  in  the  form  of  fats  ol 


2o6  Food  in  Health.  [PartL 

of  carho-hydrates.  If  in  the  form  of  fat,  then,  accord- 
ing to  Voit's  calculations,  an  average  working  man 
would  require  for  his  daily  consumption  346  grammes 
if  in  the  form  of  starch,  596  grammes.  But  it  is  no 
doubt  better  to  obtain  the  carbon  that  we  require  in 
our  food  in  part  from  both  classes  of  aliments — from 
a  mixture  of  fat  and  farinaceous  foods.  This  appears 
to  suit  the  digestive  capacities  of  man  as  well  as  his 
nutritive  requirements  best. 

Carbo-hydrates  are  not  able  to  minister  as  com- 
pletely as  the  fats  do  to  the  functions  of  tissue  growth 
and  repair  ;  wliile,  on  the  other  hand,  a  large  propor- 
tion of  fat  in  the  food  is  not,  as  a  rule,  well  tolerated 
by  the  digestive  organs  for  long  at  a  time,  unless 
under  exceptional  conditions  of  climate,  as  amongst 
the  inhabitants  of  Arctic  regions,  where  food  possess- 
ing a  relatively  large  capacity  for  heat-production  is 
especially  needed.  It  is  not  uncommon,  moreover,  to 
find  individual  peculiarities  with  regard  to  the  capacity 
for  taking  fats,  some  persons  being  incapable  of 
digesting  ])ut  very  small  quantities  ;  in  such  cases  the 
deficiency  must  be  supplied  by  a  proportionate  allow- 
ance of  carbo-hydrates. 

The  force-value  of  various  foods.— Two 
chief  conditions  determine  the  possible  amount  of  force 
that  can  be  manifested  in  the  body — 1st,  the  amount 
of  potential  energy  contained  in  the  food,  and  this 
may  be  readily  ascertained  and  expressed  in  units  of 
heat  or  of  motion ;  and  2nd,  the  degree  in  which  the 
assimilative  processes  in  the  body  are  able  to  liberate 
and  make  u.se  of  this  energy.  An  ounce  of  albumen 
if  burnt  in  oxygen  will  yield  a  certain  amount  of  heat, 
but  no  such  complete  oxidation  can  occur  in  the  body, 
for  about  one-third  of  the  constituents  of  the  albumen 
is  excreted,  incompletely  oxidised,  in  the  form  of 
urea  It  is  different  with  some  of  the  carbo-hydrates, 
and  a  soluble  carbo-hydrate,  like  sugar,  is  completely 
oxidised  within  the  ]>ody  and  converted  into  carbonic 
acid  and  water,  so  that  its  acttial  energy  in  the  body 
is  equal  to  its  theoretical  energy. 


Chap-ViiL]       Force  Value  of  Foods.  207 

It  has  been  calculated  {Parkes)  that  ^^*'i*^^"neriy " 

One  ounce  of  dry  Proteicla  yields  173 

„        Fat  „      378 

„            „        Starch  „     138 

„            „        Cane  Sugar  „      131 

,,            „       Lactin  or  Glucose  „      124 

also   that  Foot-tons  of  po- 

teiitial  energy. 

One  grain  of  Carbon  in  conversion  into  COj  yields  07 10 
„             Hydrogen        „             „     H./J  „      3000 

„  Sulphur  „  „     SO2  „      0-205 

„  Phosphorus      „  „    PjOs         „     0-510 

„  Carbon  (forming  Urea)  „      01 98 

The  following  table  embodying  Dr.  Frankland's 
experimental  results  displays  a  close  agreement  with 
theoretical  results,  and  is  useful  as  showing  what  can 
be  obtained  from  food.  It  would,  however,  be  an 
error  to  suppose  that  the  value  of  food  is  in  exact 
relation  to  the  possible  energy  it  can  yield.  To  pro- 
duce this  energy,  not  only  must  it  undergo  suitable 
preparation  and  digestion  within  the  body,  but  the 
setting  free  of  energy  must  take  place  where  and  how 
it  may  best  serve  the  purposes  of  nutrition.  "  The 
mere  expression  of  potential  energy  cannot  fix  dietetic 
value,  which  may  be  dependent  on  conditions  in  the 
body  unknown  to  us."  Gelatin,  for  instance,  cannot 
completely  supply  the  place  of  albumen,  although  its 
potential  energy  is  but  little  less,  and  it  is  reailily 
oxidised  in  the  body;  yet,  owing  to  some  unknown 
conditions,  its  energy  has  a  different  dii'ection  from 
that  of  albumen. 

According  to  Frankland, 

Heat  Units. 

One  gramme  of  dry  Isinglass  when  burnt  in  Ojy-  \  a. -on 

gen  will  develop           )  '■*" 

One  gramme  of  dry  boiled  Ham  when  burnt  in  ^  4-343 

Oxygen  will  develop ...  | 

One  gramme  of  dry  Beef  when  burnt  in  Oxygen  \  -.qiq 

will  develop      } 

which  shows  the  potential  energy  of  isinglass  to  be 
greater  than  that  of  ham,  yet  its  nutritive  power  is 
far  inferior. 

Such  tables  of  energy  are  valuable  as  affording 


208 


Food  in  Health. 


[Part  1. 


broad  indications,  and  as  representing  in  a  general 
way  the  value  of  a  diet ;  but  they  must  not  be  taken 
as  throwing  light  on  the  obscurities  of  the  nutritive 
processes. 

Energy  developed  by  1  oz.  of  the  following  foods 
when  oxidised  in  the  body  : — 


Food  Stuff. 

With  usual 

percentage  of 

water. 

One  ounce 
water-free. 

Foot-tons. 

Foot-tons. 

Beef  (best quality)         uncooked... 

49 

191 

Meat  (served  to  t^oldiers)       „ 

58 

232 

Beef,  fattened                         „ 

96 

260 

Meat,  cooked           

106 

231 

Corned  Beef  ((^hicago) 

93 

194 

Salt  Beef      

52 

102 

„    Pork     

71 

127 

Fat      „ 

202 

331 

Dried  Bacon            ... 

292 

344 

Smoked  Ham 

179 

248 

Horseflesh    ... 

48 

187 

White  Fish 

42 

191 

Poultry         

50 

192 

Bread 

88 

147 

Wheat  Flour 

124 

146 

Biscuit 

133 

144 

Rice  ... 

127 

141 

Oatmeal       

130 

153 

Maize 

131 

162 

Macaroni      

124 

142 

Millet           

126 

144 

Arrowroot 

116 

136 

Peas  (diied) 

119 

140 

Potatoes       

33 

127 

Carrols 

16 

107 

Cabbage       

13 

144 

Butter          

339 

367 

Eggs 

68 

257 

Cheese          

150 

237 

Milk  (Cow's),  new  ... 

27 

205 

Cream 

109 

321 

Skimmed  Milk 

21 

175 

Sugar            

126 

130 

Pemmican 

270 

293 

Ale  (Bass's  bottled) 

30 

260 

Stout  (Guinness)     ... 

42 

360 

Chap.  VI rn       Force  Value  of  Foods.  209 

The  advisability,  in  aiTanging  dietaries,  of  avoiding 
monotony  and  providing  variety  in  food  should  never 
be  forgotten  ;  for  the  digestibility,  and  therefore  the 
nutritive  value,  of  food  depend  greatly  on  its  palat- 
ableness,  and  the  stimulus  thereby  given  to  the 
digestive  secretions. 


210 


CHAPTER  IX. 

CEliTAIN     DIETARIES PRISON    DIETARIES — SOLDIERS* 

DIETARIES seamen's     DIETARIES. 

We  may  now  examine  with  advantage  the  construc- 
tion of  certain  dietaries,  especially  those  adopted  in 
prisons  and  in  the  army  and  navy. 

In  accordance  with  the  recommendations  of  a 
Committee  appointed  to  consider  the  question  of 
Prison  Dietaries,  in  1878,  the  Commissioners  of 
Prisons  have  adopted  the  principle  that  the  diet 
should  vary  with  the  length  of  sentence  and  the  shorter 
the  term  of  imprisonment,  the  more  strongly  should 
the  penal  element  be  manifested  in  the  diet.  They 
consider  a  spare  diet  is  all  that  is  necessary  for  a 
prisoner  undergoing  a  sentence  of  a  few  days  or 
weeks.  .  .  that  "  all  prisoners,"  whatever  their 
length  of  sentence,  should  commence  with  the  lowest 
diet,  and  "graduate  through  the  dietaries  proper  to 
all  the  sentences  shorter  than  their  own,  until  they 
reach  the  dietary  proper  to  their  own  class."  Ac- 
cording to  the  length  of  sentence  the  following  four 
classes  of  diets  are  adopted  : — 

Class  I. — For  periods  of  7  days  and  under. 

Class  II. — For  periods  of  more  than  7  days,  and  not  more 

than  1  month. 
Class  III. — For  periods  of  more  than  1  month,  and  not 

more  than  4  months. 
Class  IV. — For  periods  of  move  than  4  months. 

Class  I. — This  diet  consists  of  one  pound  of  bread 
daily,  together  with  a  hot  meal  once  a  day,  "  in  the 
shape  of  a  nutritive  stirabout,  composed  of  equal 
parts  of  oatmeal  and  Indian  meal."  No  distinction 
is  made  between  the  sexes,  nor  during  this  very  short 
term  between  prisoners  with  and  those  without  hard 
labour. 


Chap.  IX.] 


Prison  Dietaries. 


211 


Class  11. — For  prisoners  undergoing  more  than 
seven  days,  but  not  more  than  one  month's  imprison- 
ment, the  following  is  the  dietary  adopted  : — 


Breakfast 


DlNNEB 


SUPPBB 


^^^      ■-  {IS 

Mon.4Fri.{B2f^. 

Tues-.ThuTS.,  /  Bread 
&Sat.    ...    (Soup 


DaUy 


Bread 
Gruel 


Men  with 

hard 
labour. 


6  ounces 
1  pint 
8  ounces 
6       .. 


6      „ 

ipint 
6  ounces 
1  pint 


Men  with- 
out hard 

labour  and 
Women. 


0  ounces 

1  pint 

6  ounces 
5       .. 


f  pint 
5  ounces 
1  pint 


For  Class  III.,  i.e.  prisoners  undergoing  one  month 
and  not  more  than  four  months'  imprisonment,  the 
dietary  prescribed  is  the  following : — 


Breakfast     Daily 


Dinner  ...s 


Sun.  &  Wed. 


Mon.  &  Fri. 


Hen  with 

hard 
labour. 


Men  with- 
■   out  hard 
I  lal><>ur,  and 
1    Women. 


Suffer 


r  Bread        .». 
I  (iruel        ... 
Bread 

Potatoes    . . . 
Suet  Pudding 
/Bread        ...  :8 
\  Potatoes    ...  '8 
j  Cooked  Meat 
'   without  bono 

Tues.,Thur8.,  (  J^^f^f 
cat.  {  Potatoes 

^^*-    -    (Soup 
(  Bread 


8  ounces   G  ounces 
1  pint        1  pint 
4  ounces   4  ounces 
8       ,,      ;  6       „ 
8       „      1 6      ,, 

j6       » 
1 8      .. 


Daily 


\  Gruel 


3  „ 
8  „ 
b  „ 
^  pint 
6  ounces 
1  pint 


%  pint 
6  ounces 
1  pint 


o2 


212 


Food  in  Health. 


[Parti 


For  Class  IV.,  i.e.  prisoners  undergoing  more  than 
four  months'  imprisonment,  the  dietary  adopted  is  tlie 
following : — 


Brbakpast     Daily 


Dinner  ...-< 


Supper 


Sun.  &  Wed. 


Mon.  &  Fri. 


Tues.,Thurs., 
&Sat.    ... 


Daily 


Men  with 

liard 
labour. 


{Bread 
Porridge 
Gruel 
Bread 
Potatoes 
Suet  Pudding' 12 

i  Bread        ...  \  8 
Potatoes    ...  1 12 
Cooked  Meat^ 
without  bone   4 
Bread 
Potatoes 
Soup 
Bread 
Porridge 
Gruel 


8  ounces 
1  pint 

6  ounces 


12 


1  pint 
8  ounce; 
1  pint 


Men  with- 
out hard 

labour,  and 
Women. 


6  ounces 

1  pint 

4  ounces 

8  „ 
10      „ 

6  „ 
10      „ 


10  „ 
1  pint 
6  ounces 

1  pint 


Bacon  and  haricot  beans  may  be  substituted  for 
beef  in  the  Monday's  dinner;  this  would  be  superior 
in  nutritive  value  and  would  also  effect  a  considerable 
saving. 

The  application  of  the  "  progressive  "  principle  is 
"so  graduated  as  to  accommodate  itself  to  the 
circumstances  of  the  various  classes  of  prisoners," 
as  shown  in  the  following  diagram — a  prisoner  of 
the  2nd  Class  beginning  with  the  diet  of  the  1st 
Class,  and  after  seven  days  passing  on  to  that  of  his 
own  class,  and  so  on. 


Chap.  IX.]  Prison  Dietaries,  213 

DlAOKAH  TO  SHOW  APPLICATION  OF  PROGRESSIVE  PRINCIPLE. 


Term. 

Class  I. 

Class  II. 

Class  III. 

Class  IV. 

Seven  days  and  under 

Whole 
term. 

— 

— 

More  than  seven  days  \ 
and  not  more  than  J 
one  month ) 

Seven 
days. 

Remain- 
der of 
term. 

-. 

More  than  one  month  \ 
and  not  more  than  > 
four  months           . . .  ) 

— 

One 
month. 

Remain- 
der of 
term. 

— 

More  than  four  months  | 

— 

— 

Four 
months. 

Remain- 
der of 
term. 

For  making  the  bread,  whole  meal  is  employed. 

Beef  is  the  mPMt  recommended  for  healthy  prisoners 
at  labour,  and  mutton  for  the  sick  in  hospital ;  and 
in  order  that  the  prisoner  may  get  all  the  constituents 
of  the  meat,  it  is  recommended  that  the  broth  in 
which  the  meat  is  boiled  should  be  served  with  it. 

The  soup  is  recommended  to  be  made  from  the 
neck,  clod,  cheek,  leg,  or  shin  of  beef,  together  with 
split  peas,  fresh  vegetables,  and  onions.  The  propor- 
.ions  are  :  In  every  pint,  4  oz.  of  clod  (or  shoulder), 
cheek,  neck,  leg,  or  shin  of  beef ;  4  oz.  of  split  peas ; 
2  oz.  fresh  vegetables;  l|oz.  onions;  pepper,  and  salt. 

"Suet  pudding:. — Each  pound  contains  \\  oz. 
mutton  suet,  8  oz.  of  flour,  and  about  6^^  oz.  of  water. 

"  Potatoes. — The  entire  absence  of  vegetable 
acids  from  a  prison  dietary  would  result,  as  is  well 
known,  in  an  outbreak  of  scurvy,  and  tlie  potato 
is  chiefly  valuable  as  supplying  the  anti-scorbutic 
element  in  its  cheapest  form." 


214  Food  in  Health.  [Pani. 

The  gri'nel  is  made  with  2  oz,  of  coarse  Scotch  oa1>- 
meal  to  the  pint,  with  salt,  and  one  of  its  advantages 
is  that  it  can  be  served  hot. 

Porridge  is  ordered  to  be  made  with  3  oz.  of 
coarse  Scotch  oatmeal  to  the  pint,  with  salt, 

Stirabout  is  given  to  prisoners  in  Class  I.,  as 
well  as  to  prisoners  who  are  ill-conducted  or  idle.  It 
is  made  thus :  3  oz.  of  Indian  meal,  and  afterwards 
5  oz.  of  oatmeal,  are  stirred  into  2^  pints  of  boiling 
water,  to  which  \  oz.  of  salt  has  been  added ;  it  is 
kept  constantly  stirred,  and  when  it  is  evaporated  to 
a  pint  and  a  half,  the  meals  are  sufficiently  cooked. 

Cocoa  is  introduced  into  some  of  the  dietaries, 
on  the  ground  "that  the  health  of  prisoners  under- 
going long  sentences  will  be  benefited  by  the  intro- 
duction of  some  slight  change  of  diet  at  tlie  expiration 
of  nine  months  from  conviction." 

Correctional  diet. — The  most  common  diet  in 
use  for  correctional  purposes  consists  of  a  pound  of 
bread  and  a  pint  of  water  per  diem ;  its  employment 
is  limited  to  a  period  of  three  days  at  a  time.  "  After 
that,  one  of  the  undermentioned  stirabout  diets, 
according  to  labour  performed,"  should  be  given 
for  three  days  before  the  repetition  of  the  bread- 
and-water  diet  for  three  days,  "and  a  second 
interval  on  the  stirabout  diet  is  to  elapse  before  it 
is  again  repeated.  The  entire  period,  including 
intervals,  for  which  any  single  term  of  this  diet  may 
be  ordered  is  not  to  exceed  fifteen  days.  No  task  of 
laliour  is  to  be  enforced  on  any  one  of  the  nine  days 
on  which  the  bread  and  water  constitute  the  sole  food 
supplied  to  the  prisoner." 

The  "  Stirabout  Diet "  referred  to  is  as  follows : — 

\gt. — For  Men  and  Women  performing   a  Daily    Task  of  any 
Labour  not  expressly  defined  as  Hard  Labour. 
Breakfast...         ...     Bread,  8  oz. 

/  1  pint  of  Stirabout,  containing  2  oz. 
^  )      o^  oatmeal  and  2  oz.  of  Indian 

JJINNEE       ...        ...  j      meal,  with  salt. 

\  Potatoes,  8  oz. 
ScFPW.       Bread,  8  oz. 


Chap.  IX.]  Prison  Dietaries.  215 

"  This  diet  to  be  limited,  in  the  first  place,  to 
twenty-one  days ;  after  that,  the  diet  of  the  class  to 
•which  the  prisoner  belongs  for  one  week  before  its 
repetition,  when  it  is  to  be  limited  to  fourteen  days. 
The  entire  period,  including  the  interval,  for  which 
any  single  term  of  this  diet  may  be  ordered  is  not 
to  exceed  forty-two  days." 

Ind. — FhU  Stirabout  Diet  for  Men  performing  a  Daily  Task  of 
Hard  Labour. 

Bbbakfast Bread,  8  oz. 

f\\    pint    of    Stirabout,   containing 

1      3   oz.   of  oatmeal  and   3   oz.   of 
DiNiTBR       <      Indian  Meal,  with  Salt. 

j  Potatoes,  8  oz. 

i^  Bread,  8  oz. 
Supper       Bread,  8  oz. 

"This  diet  to  be  limited,  in  the  first  place,  to 
forty-two  days ;  after  that,  the  diet  of  the  class  to 
which  the  prisoner  belongs,  for  fourteen  days  before 
its  repetition,  when  it  is  to  be  limited  to  twenty- 
eight  days.  The  entire  period,  including  the  interval, 
for  which  any  single  term  of  this  diet  may  be  ordered 
is  not  to  exceed  eighty- four  days." 

The  amoiint  of  the  proximate  aliments  (as  water- 
free  solids)  in  each  diet,  as  well  as  the  amount 
of  nitrogen  and  carbon,  is  set  forth  in  the  following 
tables,  and  the  approximate  value  in  grammes  is 
added  for  pui-poses  of  comparison  : — 

Class  I. 

Men  with  and  without  Hard  Labour,  and  Women. 

Nitrogenous  Matters  (Albuminates)    200  oz.  (56-7  grammes) 

Carho-hydi-atos        12-02  „  (340-2        ,,       ) 

Fat     0-67  „  (190        „       j 

Mineral  Substances 0-76.,  (210        „       ) 

Nitrogen.  Carbon. 

0-30  oz.  (7-5  grammes).  7-44  oz.  (210-9  grammes). 


3i6  Food  in  Health,  [Pani. 

Class  n. 
(a)  Men  without  Hard  labour,  and  Women. 


Albuminates 

Carbo-hydrates        

Fat     

Mineral         .,^ 

...  2-23  oz.  (63-2  grammes) 
...  11-87  „  (336-5  „  ) 
...  0  67  „  (19-0  „  ) 
...    1-09  „       (30-9        „       ) 

Nitrogen. 

Carbon. 

0*34  oz.  (9-6  grammes). 

7*46  oz.  (211-5  grammes). 

(J)  Men  with  Hard  Labour. 

Albuminates 

Carbo-hydrates        

Fats 

Mineral         

...  2-60  oz  (70-8  grammes) 
...  13-60  „  (385-5  „  ) 
...  0-76  „  (210  „  ) 
...    M4  „        (32-3         „       ) 

Nitrogen,  Carbon. 

0-38  oz.  (10-76  grammes).    8-51  oz.  (241-26  grammes). 

Olass  m. 

(a)  Men  without  Hard  Labour,  and  Women. 

Albuminates 2*94  oz.  (85-0  grammes) 

Carbo-hydrates        ]4  32  „  (406-0        „       ) 

Pats    ..."         0-87  „  (24-6         „        ) 

Mineral ...    1-24  „  (351         „       ) 

Nitrogm.  Carbon. 

0-44  oz.  (12-4  grammes).       9-04  oz.  (266-2  grammes). 


{b)  Men  with  Hard  Labour. 

Albuminates 3-27  oz.  (92*7  grammes) 

Carbo-hydrates        16-65  „  (4720        „       ) 

Fata 0-98  „  (279        „       ) 

Mineral         „        ...    1-31  „  (37 1        „       ) 

Nitrogen.  Carbon. 

0*49  oz.  (13-7  grammes).      10*40  oz.  (2950  grammes). 


Chap.  IX.]  Prison  Dietaries..  217 

Class  IV. 

(a)  Men  without  Sard  Labour,  and  Women. 

Albuminates 3  23  oz.  (91-5  grammes) 

Carbo-hydrates        15ol  „  (4400        „       ) 

Fat 1-00  „  (•28-35      „       ) 

Mineral         1-27  „  (36  00      „       ) 

Nitrogen.  Carbon. 

0*49  oz.  (14-0  grammes).        984  oz.  (2790  grammes). 

(i)  Mtn  with  Hard  Labour. 

Albuminates 409  oz.  (1160  gi-ammes) 

Carbo-hydrates        20-17,,  (572  0        „       ) 

Fat     1-30  „  (37  0        „       ) 

Mineral         \bh  „  (440        „       ) 

Nitrogen.  Carbon. 

0-61  oz.  (170  grammes).      12*78  oz.  (362-3  grammes). 

On  examination  of  these  diets,  it  will  be  seen  that 
Class  I.  contains  about  the  same  quantities  of  the 
several  alimentary  substances  as  are  contained  in 
Playfair's  .subsistence  diet ;  and  as  it  is  only  applic- 
able to  the  short  period  of  seven  days,  its  defects 
are  not  likely  to  be  attended  by  any  serious  con- 
sequences unless  prisoners  are  set  to  "  hard  labour  " 
when  on  this  diet.  For  this  it  is  quite  inadequate, 
even  for  so  short  a  period ;  and,  as  the  offences  for 
which  such  short  sentences  are  considered  a  sufficient 
punishment  are  of  the  most  trivial  nature,  there 
seems  to  be  no  good  reason  for  insisting  on  such 
a  highly  correctional  dietary  for  these  the  least 
criminal  of  offenders. 

The  diet  for  Class  II.  is  of  more  importance,  as  it 
applies  to  sentences  of  one  month ;  and  a  defective 
diet — if  it  should  be  defective— for  that  length  of 
time  might  have  an  injurious  effect  on  the  prisoner's 
health.  And  it  should  be  remembered  that  the  loss 
of  health  attending  such  a  diet  is  not  so  likely  to 
make  itself  manifest  during  as  immediately  after 
this  short  term  of  imprisonment,  when  the  prisoner 
attempts   to  resume  his   daily  labour;   so  that   the 


2l8 


Food  in  Health. 


[Part  I. 


statistics  of  the  health  of  the  prisoners  t^Atfe  inpnson 
would  scarcely  bear  on  these  cases. 

Again,  we  have  also  to  consider  that  a  sentence 
of  a  month's  imprisonment,  vnthout  hard  labour,  is 
often  the  punishment  of  very  trivial  offences,  and 
certainly  not  such  as  would  seem  to  call  for  a  severely 
correctional  diet. 

This  diet  is  very  little  in  excess  of  Playfair's  mere 
subsistence  diet,  and  much  below  Moleschott's  esti- 
mate of  what  is  necessary  for  a  man  in  ordinary  work. 
The  defect  is  chiefly  in  albuminates  : — 


Class  n.— Prison  Diets. 


Albuminates 

Carbo-hydrates 

Fats 

Salts 


oz.     grammes. 

2-23  or    63-2 

11-87  „  336-5 

0-67  „     19-0 

1-09  „     30-9 


Playfair's  Sub- 
sistence Diet. 


oz.  grammes. 
2-0  or    57 
12-0  „  340 
0-5  „     14 
0-5  „     14 


Moleschott's. 


oz.  Ri-ammes. 
459  or  130 
14-26  „  404 
2-96  „  84 
1  06  „     30 


The  diet  for  men  of  this  class,  with  hard  labour, 
though  more  satisfactory,  is,  no  doubt,  defective 
in  albuminates  and  fats.  This  will  be  seen  by 
comparing  it  with  the  average  of  several  dietaries 
calculated  for  men  in  ordinary  work : — 


Prison  Diet,  Class  11. 

Mean  of 

several  Diets 

(Parkcs). 

Deficiency. 

grammes. 

Albuminates        70*8 

Carbo-hydrates 385-o 

Fats           21-0 

Salts          32-3 

grammes. 

122 

332 

100 

28 

grammes. 

51-2 
(+  53-5) 

79-0 
(+     4-3) 

As  has  been  already  pointed  out,  the  effects  of 
such  a  dietary  could  only  be  accurately  estimated 
by  statistics  of  the  health  of  prisoners  after  their  dis- 
charge from  such  short  terms  of  imprisonment. 


Chap.  IX.] 


Prison  Dietaries. 


219 


The  hard  labour  diets  of  Classes  III.  and  IV. 
appear  ample,  even  when  compared  with  the  liberal 
estimate  of  Moleschott,  except  that  they  are  very 
defective  in  fats,  which  defect  can  scarcely  be 
compensated  for  by  the  relative  excess  of  carbo- 
hydrates. 


Prison  Diet:  Class  III.  and  Class  IV. 


Moleschott's. 


Albuminates 

Carbo-hydrates 

Fats 

Salts 


grammes. 

92-7 

,     472-0 

27-9 

371 


grammes. 

116-0 

572-0 

37-0 

44-0 


grammes. 

130 

404 

84 

30 


These  diets  would  certainly  be  improved  by  in- 
creasing the  proportion  of  fats  and  diminishing  the 
carbo-hydrates  to  a  corresponding  amount. 

In  connection  with  these  prison  diets,  Dr. 
de  Chaumont's  remarks  on  the  effect  on  soldiers  of 
imprisonment  in  convict  prisons  are  particularly  in- 
teresting. He  says,  referring  to  the  circumstance  that 
soldiers  are  sometimes,  as  a  matter  of  convenience,  con- 
fined in  convict  prisons  :  "  The  ordinary  diet  which  is 
sufficient  for  the  convict  is  insufficient  for  the  soldier, 
and  that  for  several  reasons:  (1)  the  convict  is  on 
the  average  a  smaller  man.  (2)  The  previous  life  of 
the  convict  is  an  irregular  one,  in  which  his  food  is 
generally  insufficient ;  wliereas  the  soldier's  life  is 
usually  the  opposite — his  food  is  fairly  good  and  his 
meals  are  regular.  (3)  The  crimes  for  which  the 
convict  is  imprisoned  are  crimes  against  society,  and 
his  removal  to  a  prison  cannot  be  considered  much 
of  a  degradation  morally,  whereas  his  physical  con- 
dition is  reall}'  improved  ;  on  the  other  hand,  the 
soldier's  crime  is  often  one  of  a  military  character  only; 
hence  his  removal  to  a  prison  is  a  moral  degradation, 
especially  if  it  be  a  convict  prison.  Tlie  result  is  that, 
whilst  the  majority  of  the  civil  prisoners  retain  their 


220 


Food  in  Health. 


[Part  I. 


weight  or  even  gain,  the  majority  of  soldier  prisoners 
lose." 

The  sol<1icr's  dietary.  —  The  soldier's  daily 
rations  when  on  home  service  which  he  receives  from 
Government  consist  of  1  lb.  of  bread  and  \  lb.  of 
meat ;  he  also  has  "  an  allowance,  in  the  nature  of 
partial  board  wages,  estimated  at  5d.  a  day,  which  is 
supposed  to  be,  and  which,  according  to  regulations, 
may  be  expended  on  his  diet." 

Parkes  gives  the  following  table  as  representing 
the  usual  articles  of  food,  with  nutritive  value  in  ounces 
avoirdupois,  which  each  soldier  consumes  daily  : — 


Articles  of  Food. 

Quan- 
tity. 

Water. 

Albu- 
min- 
ates. 

Fat. 

Car- 
bo-hy- 
drates. 

Salts 

Total 

Water 

free 

Food. 

Meat  {\  bone)    ... 

Bread      

Potatoes 

Green     or    other ) 
Vegetables     ...  | 

Milk        

Sugar      

Salt          

Coffee     

Tea         

oz. 
12-00 
24-00 
16-00 

8-00 

3-25 
1-33 
0-2o 
0-33 
0-16 

7-20 

9  60 

11-84 

7-28 

2*82 
0-04 

1-44 
1-92 
0-32 

0-14 

0-13 

OSl 
0-36 
0-02 

0  04 

0-12 

11-81 
3-36 

0-46 

0-16 
1-29 

•15 
-31 
0-2 

0-6 

0-2 

•25 

2-40 

14-40 

3-72 

0-70 

0-43 
1-29 
©•2o 

Total  quantity  ... 

65-32 

38-78 

3-95 

1-36 

17-08 

•81 

23- 19 

Calculating  out  the  nitrogen,  carbon,  etc.,  in  these 
substances,  we  get : — 

Nitrogen    ...         

Carbon  in  Albuminates   ...       837 

„         Fats      454 

„         Carbo-hydrates      3,297 
Hydrogen  in  Albuminates         51  ) 
„  ^        Fats            ...        65  j 
Sulphur  in  Albuminates 


272 

gi-ains. 

4,588 

» 

116 

» 

32 

<i 

C3iap.  IX.] 


Soldiers'  Dietaries. 


To  compare  it  with  Moleschott's  standard  diet,  we 
must  state  the  quantities  in  grammes  : — 


English 
Soldier's  Diet. 


Albuminates 

Fat 

Carbo-hydrates 

Salts 


Parkes  observes  with  regard  to  this  diet  that  it 
contains  considerably  less  nitrogen  than  the  standard 
diet,  as  is  indeed  evident  by  the  comparison  we  have 
given  above ;  that  it  contains  about  the  correct 
amount  of  carbon,  but  it  would  be  better  if  less  of  the 
carbon  were  obtained  from  carbo-hydrates  and  more 
from  fat.  He  recommends  the  addition  of  more  meat 
or  of  cheese,  and  the  addition  also  of  butter  or  some 
other  fat  or  oil.  He  also  suggests  the  introduction  of 
peas  and  beans,  as  in  the  French  army.  Professor 
de  Chaumont  was  also  of  opinion  that  the  food  of  the 
soldier  is  deticient,  especially  for  the  younger  men, 
and  he  thought  it  highly  desirable  that  the  ration  of 
meat  should  be  increased.  From  inquiries  among 
soldiers,  he  found  that  the  recruits  and  young  soldiers 
could  eat  much  more;  though  the  old  soldiers,  "many 
of  whom  had  been  long  accustomed  to  take  spirits,  and 
who  had  injured  their  digestive  powers  by  so  doing, 
took  less  food." 

Parkes  calculated  that  "  the  total  energy  obtain- 
able in  the  body  from  the  soldier's  daily  diet  appears 
to  be  equal  to  lifting  3,542  tons  one  foot.  The 
amount  for  the  internal  and  external  mechanical  work 
of  the  body  being  taken  at  600  tons  lifted  a  foot, 
there  remains  2,942  tons  for  the  animal  heat  and  all 
the  other  processes."  He  points  also  to  the  deficiency 
of  condiments   in  the   soldier's  food,  and  advocates 


222  Food  in  Health,  [Pani. 

especially  the  use  of  vinegar,  as  a  digestive  agent,  a 
flavourer,  and  an  anti-scorbutic. 

The  Report  of  a  Committee  appointed  to  inquire 
into  the  question  of  Soldiers'  dietary,  was  presented 
to  both  Houses  of  Parliament  in  June,  1889,  and 
contains  some  interesting  matters  bearing  on  this 
subject. 

It  points  out  that  as  the  soldier  receives  an 
allowance  for  food  as  well  as  a  ration  of  \  lb.  of  meat 
and  1  lb.  of  bread,  the  question  is  not  whether  these 
are  sufficient  in  themselves,  "  but  whether  these  sup- 
plies, supplemented  by  other  articles  provided  out  of 
the  messing  stoppage,  afford  a  sufficient  diet  for  the 
soldier."  The  evidence  of  the  manager  of  Pearce's 
Dining  and  Refreshment  Rooms,  an  institution 
supplying  about  30,000  meals  daily  to  carmen, 
bricklayers,  etc.,  in  London,  showed  that  the  average 
amount  of  meat  without  bone  supplied  to  each  man 
for  dinner  was  5  oz.  uncooked,  yielding  when  cooked 
about  4  oz. 

According  to  Brigade-Surgeon  Maunsell,  who 
weighed  1,232  rations,  the  average  amount  of  cooked 
meat  supplied  daily  to  the  soldier  was  7  oz.  1  dram, 
exclusive  of  bone  and  dripping. 

The  Report  also  points  out  that  the  British 
soldier  receives  a  larger  meat  ration  than  any  Con- 
tinental soldier,  and  that  with  the  existing  scale  of 
diet  recruits  almost  invariably  increase  in  weiglit. 

The  most  interesting  and  most  practical  part  of  the 
Report  is  that  which  refers  to  the  considerable  success 
which  has  attended  the  experiments  of  Colonel  Burnett 
of  the  1st  Battalion  Royal  Irish  Rifles  at  INIuUingar, 
for  supplying  his  men  with  what  Surgeon-Major 
Notter,  Professor  of  Military  Hygiene  at  Netley, 
has  described  as  a  model  diet,  with  a  stoppage  of 
only  3d.  instead  of  5d.  a  day.  This  system,  or  one 
somewhat  similar,  appears  also  to  exist  in  many  other 
regiments.  Complaints  as  to  the  quality  of  the  bread 
supplied  to  the  army,  the  Report  states,  were  almost 
universal  and  well-founded.    It  was  often  imperfectly 


Chap.  IX.]  Soldiers'  Dietaries.  223 

baked  and  became  stale  and  sour  within  a  few  hours  of 
its  issue.  Large  quantities  of  ration  bread  were  thrown 
away  by  the  troops  and  other  bread  was  purchased  in 
its  place. 

As  the  class  from  which  the  army  is  recruited 
rarely  eat  dark-coloured  bread,  and  have  a  great 
prejudice  in  favour  of  Avhite  bx'ead,  it  is  recommended 
by  the  Committee  that  the  ration  bread  should  be 
made  from  the  same  class  of  flour  as  the  hospital 
bread. 

The  Committee  strongly  advise  the  observance  of 
more  care  and  skill  in  cooking,  as  well  as  the  saving 
and  utilisation  of  the  dripping  in  improving  the  diet 
(in  that  particular  in  which  it  is  most  defective,  viz. 
in  fat),  and  the  bones  for  making  soups.  Cooking  in 
some  regiments  was  found  to  be  attended  with  nmch 
greater  waste  than  in  others — in  one,  34  lb.  8  oz.  of 
mutton  lost  in  cooking  9  lb.  10^  oz.  ;  whereas  in 
another,  27  lb.  12  oz.,  also  of  mutton,  lost  only  4  lb. 
8i  oz. :  so  that  in  one  case  the  soldier  received  only 
6^  oz.,  in  the  other  as  much  as  7|  oz.  of  cooked 
meat. 

It  has  been  recognised  that  the  interval  be- 
tween the  light  tea  meal  at  4  p.m.  and  breakfast  next 
day  at  7  or  8  a.m.  is  too  long  for  the  soldier, 
and  especially  the  young  soldier,  to  be  without  food. 

The  Committee  consider  that  the  chief  defects  in 
the  soldier's  diet  are  due  to  insufficient  interest  being 
taken  in  this  subject  by  tiie  officers,  and  that  the 
soldier's  rations,  supplemented  by  even  a  smaller 
sum  than  the  authorised  messing  contribution  of  .^d. 
a  day,  afford,  with  proper  regimental  arrangements,  a 
sufficient  diet. 

In  an  appendix  to  their  Report  the  Committee 
publish  a  Memorandum  from  Colonel  C.  J.  Burnett 
setting  forth  the  "  innovations  and  improvements  "  he 
has  made  in  the  messing  and  rations  of  the  men  under 
his  command.  For  a  full  account  of  Colonel  Burnett's 
system  the  reader  must  consult  this  Report. 

Surgeon-Major  J.  L.  Notter,  Professor  of  Military 


224  Food  in  Health.  [Parti. 

Hygiene,  Army  Medical  School,  reporting  on  this 
system,  says: — 

"  I  have  at  last  completed  working  out  the  value 
of  your  diets,  and  I  must  say  it  has  astonished  me. 
You  have  done  wonders  in  the  way  of  improving  the 
soldier's  food." 

Colonel  Burnett  has  succeeded  completely  in 
showing  that  "  with  the  Government  ration,  supple- 
mented by  a  stoppage  of  3d.  per  day  from  the  soldier, 
the  demands  of  science  in  the  matter  of  feeding  the 
Army  can  be  satisfied,"  and  Dr.  Notter  adds,  "  The 
ration  Colonel  Burnett  issues  is  ample,  and  he  states 
he  can  provide  this  anywhere  without  extra  cost." 

For  campaigning  no  strict  scale  of  diet  is  or  can 
be  laid  down ;  it  would  have  to  be  tixed  at  the  time, 
and  would  depend  on  the  character  of  the  campaign. 
The  scale  should  be  very  liberal,  and  besides  the 
usual  articles  of  diet,  extras  should  be  supplied  for 
special  purposes,  such  as  forced  marches,  rapid  move- 
ments at  a  distance  from  the  base  of  supplies,  etc. 
The  usual  ration  should  contain  at  least  375  to  400 
grains  of  nitrogen.  Parkes  suggests  the  following  as 
a  liberal  and  varied  war  ration : — 


Bread          ...         ...         ...         ,.. 

...       li  lb. 

Fresh  Meat,  without  bone 

...       1    ,, 

Peas  or  Beans       

3   oz. 

Potatoes  and  Cireon  Vegetables... 

...       1    lb. 

Cheese        

2   oz. 

Sui^ar         

...       2     „ 

Salt 

...         k  ., 

Pepper       

Ground  Cott'ee      

...        1      » 

Tea 

...           i   ,, 

Red  Wine 

...     10     „ 

Or  Beer     

...     20     „ 

The  nutritive  value  of  this  diet  is  about  380  gi-ains 
of  nitrogen  and  5,000  of  carbon. 

As  useful  extras  he  mentions  salt  meat,  Australian 
meat,  Chicago  meat,  dried  meat,  Liebig's  Extract,  pea 
and  beef  sausages,  biscuits,  flour,  meat  biscuits,  rice, 


Chap.  IX.]  Dietary  for  India.        .  225 

lime  juice,  preserved  vegetables,  brandy  or  rum,  and 
vinegar. 

"  Bread  (which  should  be  well  baked)  should  be 
issued  as  long  as  possible  ;  and,  if  biscuit  is  issued  for 
more  than  a  week,  flour  or  rice  should  be  added  to  it. 
When  salt  meat  is  issued  for  several  clays  in  succes- 
sion, vinegar  should  be  given  with  it.  If  no  vegetables 
can  be  obtained,  lime  juice  should  be  early  had  re- 
course to."  He  strongly  advises  that  red  wine  or  beer 
should  be  supplied,  and  not  spirits.  All  the  Conti- 
nental armies  issue  wine  rations  in  war.  The  use 
of  concentrated  and  cooked  foods  is  very  important 
for  rapid  expeditions. 

The  dietary  suitable  for  India  and  for  service  in 
tropical  countries  must  be  proportionate  to  the  amount 
of  mechanical  work  done,  as  in  temperate  climates. 
In  India,  as  elsewhere,  it  must  balance  the  expendi- 
ture of  energy.  It  has  been  thought  that  it  would 
be  beneficial  to  derive  the  food  supplies  more  exten- 
sively from  the  vegetable  kingdom  in  India  than  at 
home,  so  as  to  restrict  the  amount  of  animal  food 
taken  within  comparatively  narrow  limits.  But  the 
testimony  of  some  of  the  most  experienced  medical 
officers  is  opposed  to  this.  "  It  has  often  been  said 
that  Europeans  in  India  should  imitate  the  natives  in 
their  food,  but  this  opinion  is  based  on  a  misconcep- 
tion. The  use  of  ages  has  accustomed  the  Hindu  to 
the  custom  of  taking  large  quantities  of  rice,  with 
pulses  or  corn.  Put  a  European  on  this  diet,  and  he 
could  not  at  first  digest  it ;  the  very  bulk  would  be 
too  much  for  him.  The  Hindu,  with  this  diet,  is 
obliged  to  take  large  quantities  of  condiments 
(pepper,  etc. ).  The  European  who  did  the  same  would 
produce  acute  gastric  catarrh  and  hepatic  congestion 
in  a  very  short  time."  It  is  certain  that  in  the 
Indian  climate  spirits  are  injurious,  and  wine  and 
beer  should  be  taken  in  great  moderation.  The  men 
should  not  be  allowed  more  than  a  quart  of  beer  a 
day,  and  they  would  be  healthier  with  a  pint.  In 
the  hot  stations  and  seasons  entire  abstinence  from 


226 


Food  in  Health. 


[Part  I. 


alcoholic  stimulants  should  be  the  rule,  and  tea  and 
coffee  should  be  chosen  as  the  best  beverages.  The 
tendency  to  scurvy,  which  is  greater  in  the  Tropics 
than  at  home,  points  to  the  desirability  and  importance 
of  consuming  a  due  proportion  of  fruit. 

Ration  of  the  French  soldier. — Dujardin- 
Beaumetz  makes  the  remarkable  statement  that  the 
ration  of  the  French  soldier  is  superior  to  that  of  the 
soldiers  of  other  armies,  an  opinion  which  another 
French  authority,  Prof.  Germain  See,  is  far  from 
sharing,  who  points  out  the  superiority  of  the  ration 
of  the  British  soldier,  and  expresses  great  dissatis- 
faction both  as  to  the  quantity  and  quality  of  the 
French  soldier's  rations. 

The  State  provides  the  meat  at  thirty-five  per  cent, 
under  market  price ;  it  also  supplies  the  common 
bread  {jpain  de  munition).  The  white  bread  (pain  de 
soupe)  has  to  be  bought  by  the  soldier.  For  this  and 
other  articles  of  diet  he  has  to  subscribe  forty-three 
centimes  out  of  his  daily  pay  of  forty-eight  centimes, 
leaving  him  five  centimes,  i.e.  a  halfpenny,  to  receive 
in  cash.     His  dietary  consists  of — 


Grammes. 

Oz.  avoir. 

Munition  Bread 

White  Bread  (for  Soup) 

Meat  (uncooked) 

Vegetables  (green)         

(dried)          

Salt          

Pepper     

760 

260 

300 

100 

30 

IS 

2 

26-4 

8-8 
10-6 

3-6 

1-1 

0-5 
(31  gi'ammes) 

Total        

1457 

51-00 

550  grammes  of  biscuit  are  sometimes  given  in  place 
of  bread,  and  250  grammes  of  salt  beef  or  200  of  salt 
pork  in  the  place  of  fresh  meat.  The  dried  vegetables 
consist  chiefly  of  haricot  beans. 


Chap.  IX.)        French  Soldier's  Ration  227 

Parkes  calculates  that  the  French  soldier  gets  a 
total  of  51  ounces  of  solid  food  against  the  British 
soldier's  65  ounces ;  but  when  estimated  as  "  water- 
free  "  food  he  gets  24*7  ounces  against  the  British 
soldier's  23-2  ounces.  This  is  due  to  the  circumstance 
that  the  French  soldier  gets  a  much  larger  ration  of 
bread,  viz.  35  ounces  against  24,  which  is  the  British 
soldier's  ration.  On  the  other  hand,  the  British 
soldier  usually  gets  16  ounces  of  potatoes,  which  con- 
tain nearly  75  per  cent,  of  water. 

The  French  soldier  gets  too  much  bread  and  too 
little  meat.  Owing  to  the  lai-ge  quantity  of  bread  in 
it,  his  diet  calculates  out  much  richer  both  in  albu- 
minates and  carbo-hydrates  than  that  of  the  British 
soldier;  but  it  is,  on  the  whole,  a  less  nutritious 
diet. 

In  Algiers,  16  grammes  of  rice  are  added  to  the 
French  soldier's  rations ;  and  when  on  the  march 
sugar,  coffee,  and  \  litre  of  wine  are  issued.  In  time 
of  war  he  gets — 


Meat  (without  bone)    

8-40  oz, 

Bread  (or  Biscuit,  26-5  oz.) 

...     35-30  „ 

Dried  Vegetables 

...       2-12  „ 

Salt         

...       0-50  „ 

Sugar      

...      0-70   „ 

Coltee     

...       0-60   „ 

Total      47-62  „ 

Nine  ounces  of  wine  or  2\  ounces  of  brandy 
are  sometimes  served  out  instead  of  the  sugar  and 
coffee. 

Germain  S^e  calls  attention  to  the  excessive 
quantity  of  bread  in  the  French  soldier's  ration,  much 
of  which,  he  says,  is  not  consumed,  and,  if  it  were,  it 
could  not  be  digested.  He  also  very  properly  points 
out  that  at  the  age  when  men  enter  the  ai-my  as 
recruits  it  is  a  serious  error  to  suppo.se  that  their 
growth  is  complete.  Many  parts  of  the  body  do  not 
reach  their  complete  and  permanent  state  "till  five- 
and-twenty  years  of  age,  or  even  beyond  that  period, 
p2 


228 


Food  in  Health. 


[Part  I. 


The  young  soldier  should  then,  from  a  nutritive  point 
of  view,  be  regarded  as  still  in  the  period  of  growth 
and  development,  and  his  food  should,  therefore,  not 
only  be  sufficient  to  maintain  the  integrity  and 
activity  of  his  bodily  organs,  but  also  contribute  to 
his  further  growth."* 

The  Ocrman  soldier  receives  a  small  and  a 
large  ration  ;  the  latter  he  gets  when  on  marches  or 
manoeuvres,  etc.  They  consist  of  the  following  food 
substances : — 


Smaller 
Ration. 

Larger 
Ration. 

Bread   ... 

Meat  (uncooked)         

Rice      

Or  Unhusked  Barley  (Gro.iV ) 

Or  Peas  or  Beans 

Or  Potatoes .. . 

Salt       

Coffee 

oz.  av. 

•26  •oO 
6  00 
3  20 
4-21 
8-22 

53^08 
0-87 
0-468 

oz.  av. 

26-50 
8-82 
4-22 
5-28 

10-60 

70-50 
0-87 
0-468 

Parkes  calculates  that,  when  of  best  quality,  these 
would  furnish — 


Smaller  Eation 
Larger       ,, 


Albumin- 
ates. 


oz.  av. 
4-8 
5-7 


Fats. 


oz.  av. 

ri 

1-4 


Carbo- 
hydrates. 


oz.  av. 

17-4 

18-0 


Salts. 


oz.  av. 
1-5 
1-6 


Total 

Water- free 

Food. 


oz.  av. 

24-8 
27-3 


The  German  soldier  gets  a  little  more  bread  than 
the  British  soldier,  but  less  meat.  He  also  gets  a 
ration  of  rice,  which  neither  the  British  nor  French 
soldier  gets  on  home  service. 


•Germain  S^e  :  "Du  Regime  Alimentaire. 
Soldat." 


Kdgime  du  Jeune 


Chap.  IX.)       Austrian  Soldier's  Ration. 


229 


During  the  Franco-German  War  the  daily  Geitnan 
ration  (independent  of  certain  extra  issues,  when  pos- 
sible, of  bacon,  preserved  and  smoked  meats,  peas, 
white  beans,  potatoes,  etc.,  in  order  to  change  the  diet) 
was :  — 


One  of 
these 


Bread  (or  Biscuit,  17  oz.) 
Fresh  or  Salt  Meat     ... 
Salted  Beef  or  Mutton 
Bacon  ... 
Rice 

One  of  (  g'^^^^J' °^  <^^^*-^       - 

thPSfi  \  Peas  or  Beans 

tiiese  (j^^^j. 

Potatoes 

Salt       

Coffee 


265    oz. 
13       „ 


I 

)  or  1 


4-4 
4.4 


8-8    „ 
3-3  lb. 
0  7  oz. 
0- 


(unroasted) 
(roasted) 


Tlie  Austrian  soldier  receives  in  time  of 
peace  :  bread,  31  oz.,  and  meat  (without  bone),  6 '6  oz.; 
suet,  06  oz.  ;  flour  (or  vegetables),  2-5  oz.  ;  salt,  0-6  oz. ; 
with  a  little  garlic,  ouions,  and  vinegar.  In  war  time 
the  diet  is  variable.  On  four  days  fresh  pork  is  issued, 
6i  ounces  daily ;  on  one  day,  salt  pork,  6  ounces  ;  on 
another  day,  beef,  6  ounces ;  and  another,  smoked 
bacon,  6  ounces.  There  is  also  an  issue  of  butter  or 
fat  in  addition.  He  has  also  a  weekly  issue  of  biscuit 
(24-2"  ounces),  flour  (1764  ounces  for  bread  and  cook- 
ing), sauerkraut  (5.}  ounces),  potatoes  (9  ounces),  peas 
(5}  ounces),  and  barley  (5  ounces) ;  also  wine,  brandy, 
and  beer.     These  diets  yield — 


In  time  of  peace  . . . 

In  time  of  war  \ 

average        ...  | 


Albumin- 
ates. 


3-7 
4-5 


Fats. 


1-6 
3-2 


Carbo- 
hydrates. 


17-0 

22-8 


Salts. 


1-0 

ro 


Water-free 
Food. 


23-3 
31-5 


The  peace  ration   contains   too  much  bread,   too 
little  meat,  and  too  little  fat. 


230 


Food  in  Health. 


[Part  I- 


The  Russian  soldier  has  196  meat  days  and 
169  fast  days  in  the  year. 

On  the  meat  days  he  gets  meat  and  schtschi 
(cabbage  soup),  and  buckwheat  gruel  ;  on  fast  days 
the  meat  is  replaced  by  peas  and,  occasionally,  fish. 
He  has  a  daily  issue  of  42  ounces  of  rye  bread.  The 
nutritive  value  of  this  diet  has  been  estimated  as 
follows,  in  ounces  avoirdupois  : — 


Albuminates. 
5-8 


Fat. 
1-0 


Carbo-hydrates. 
250 


Salts. 
2-5 


Water-free  Food. 
34-3 


On  the  march  he  gets  24|-  ounces  biscuit  instead 
of  bread.  On  rare  occasions,  brandy,  135  fluid  ounces 
per  annum  in  5  ounce  rations,  is  served  out. 

The  following  is  the  fresh  meat  ration  of  European 
armies,  calculated  in  ounces  avoirdupois,*  extracted 
from  a  statement  prepared  by  Professor  J.  L.  Notter, 
M.D.  :— 


England           

•  ■• 

..       12-0    oz 

France  ... 

10-58   „ 

Germany  |  f'"'^^'"'  ^'^^^^^      - 
•>  (larger        „ 

3-80    „ 
8  81    „ 

Austria... 

9-87    „ 

Belgium           

8-81    „ 

Holland            

8-81    „ 

Switzerland 

..     u-o    „ 

Italy      

6  34    „ 

Denmark 

8-74    „ 

Sweden 

567   „ 

Russia 

705    „ 

Turkey 

906   „ 

It  would  be  extremely  valuable,  in  the  case  of 
long  sea-voyages,  and  for  armies  campaigning,  if 
food  could  be  so  concentrated  that  it  might  occupy 
but  a  small  an)ount  of  space  and  yet  lose  none  of  its 
nutritious  qualities.  It  would  appear,  however, 
to  be  impossible  to  procure  the  food  necessary  for 

*  Report  of  the  Committee  appointed  to  inquire  into  the  ques- 
tion of  Soldiers'  Dietary.  Presented  to  both  Houses  of  Parliament, 
June,  1889. 


Chap.  IX.]  Seaman's  jRation.  231 

maintaining  unimpaired  the  work  and  activities  of  the 
body  in  a  digestible  form  in  a  less  bulk  than  22  or  23 
water-free  ounces.  Concentration,  according  to  Parkes, 
cannot  be  carried  beyond  this,  and  practically  has  not 
even  reached  this  extent.  "  Life,  however,  and  vigour 
may  for  some  days  be  preserved  with  a  much  less 
amount ;  and  the  total  amount  of  food  has  been 
reduced  to  11  water-free  ounces  daily,  with  full  reten- 
tion of  strength  for  seven  days,  though  the  body  was 
constantly  losing  weight.  For  expeditions  of  three  or 
four  da\ s,  if  tiansport  were  a  matter  of  great  diffi- 
culty, soldiers  might  be  kept  on  10  or  12  ounces  of 
water-free  food  daily,  provided  they  had  been  fully 
fed  beforehand,  and  subsequently  had  time  and  food 
to  make  up  the  tissues  of  their  own  body,  which  would 
be  expended  in  the  time,  and  would  not  have  been 
replaced  by  the  insufficient  food." 

In  the  British  Navy,  when  fresh  provisions  can 
be  jjrocured,  a  seaman's  full  daily  allowance  consists 
of  1  lb.  of  fresh  meat,  \  lb.  of  vegetables,  1^^  lb.  of 
biscuit,  or  li  lb.  of  soft  bread ;  2  oz.  of  sugar,  1  oz.  of 
chocolate,  \  oz.  of  tea,  and  \  pint  of  spirit.  He  also 
has  weekly  3  oz.  of  oatmeal,  \  oz.  of  mustard,  \  oz.  of 
pepper,  and  \  pint  of  vinegar.  When  fresh  provisions 
cannot  be  procured,  he  gets  daily  either  1  lb.  of  salt 
pork  or  salt  beef,  or  \  lb.  of  preserved  meat ;  and  in 
addition  o\\  certain  days  \  lb.  of  split  peas,  with 
celery  seed  to  flavour  the  soup  made  from  them. 
On  other  days  he  gets  flour  9  oz.,  raisins  \\  oz.,  suet 
\  oz.,  to  make  into  a  pudding ;  and  on  other  days 
either  4  oz.  of  preserved  potato,  or  4  oz.  of  rice,  or 
2  oz.  of  each. 


232 


CHAPTER  X 

THE  ORDER  AND  FREQUENCY  OP  TAKINQ  FOOD. 

It  has  become  an  almost  universal  custom  in  civilised 
life  to  appropriate  certain  fixed  times  in  the  day  for 
taking  food.  Not  only  does  this  practice  appear  to 
Vje  well  suited  to  our  physical  organisation,  and  there- 
fore most  consistent  with  health,  but  it  is  obviously 
a  necessary  condition  of  a  life  full  of  i)liysical  and 
intellectual  activity  and  occupation,  such  as  the  great 
majority  of  civilised  human  beings  lead. 

Reference  has  been  made  by  various  a\ithors  to 
the  habits  of  feeding  of  other  animals,  and  attention 
has  been  directed  to  the  long  periods  during  which 
the  carnivorous  animals  are  accustomed  to  go  without 
food  as  compared  with  the  almost  continuous  feeding 
of  some  of  the  herbivora.  But  none  of  these  animals 
in  their  natural  state  lead  an  existence  at  all  analogous 
to  that  of  civilised  human  beings,  and  when  such 
herbivorous  animals  as  the  horse  or  the  ox  are  applied 
to  the  service  of  man,  the  same  mode  of  feeding,  viz. 
at  regular,  fixed  intervals,  is  foun<l  to  suit  them 
perfectly  well.  The  carnivorous  animal  usually  con- 
sumes an  enormous  quantity  of  food,  if  he  can  obtain 
it,  at  each  meal  and  then  })asses  into  a  condition  of 
torpor  and  lethargy,  and  the  liuman  being  who 
attempts  to  imitate  his  habits  of  feeding  will  be  found 
to  be  affected  with  the  same  kind  of  languor  and 
incapacity  for  exertion  after  meals. 
(  In  fixing  the  intervals  which  sliould  occur  between 

*  meals,  it  is  necessary  to  bear  in  mind  that  the  rate 
of  digestion  varies  considerably  in  different  persons 
and  at  different  ages,  and  that  it  is  also  greatly  in- 
fluenced by  habits  and  occupation. 


Chap.  X.]  Hours  of  Taking  Food.  233 

It  has  been  estimated  that  it  requires  from  four 
to  five  hours  to  digest  au  average  meal ;  but  some 
meals  and  certain  kinds  of  food  require  a  longer  time 
than  this,  while  for  some  kinds  of  food  a  shorter 
period  is  sufficient.  In  a  growing  active  youth  or  a 
healthy  child,  fed  on  appropriate  and  readily  digested 
food,  the  digestive  process  is  comparatively  rapid,  and 
the  intervals  between  meals  should  therefore  be 
shorter  than  in  the  case  of  adults.  So  also  in  adults 
leading  an  active  out-of-door  life,  the  food  taken  at 
each  meal  will  be  digested  more  rapidly  and  more 
completely  than  in  the  case  of  persons  of  middle  age 
following  a  sedentary  occupation. 

In  Great  Britain  (with  the  exception  of  boys  and 
girls  at  school,  who  are  often  required  to  go  too  long 
without  food)  the  tendency  no  doubt  is  to  eat  at  too 
short  intervals,  and  in  many  cases  indigestion  arises 
from  the  stomach  being  frequently  called  upon  to 
commence  the  digestion  of  a  fresh  meal  before  it  has 
completed  that  of  the  preceding  one. 

The  first  meal  of  the  day  is  breakfast,  and  it  is 
a  very  important  one.  In  the  case  of  active  persons 
leading  wholesome,  regular  lives,  it  should  be  taken 
as  soon  after  rising  as  possible.  Persons  who  require 
to  take  exercise  before  breakfast  are  either  dyspeptic 
or  overfed  ;  and,  except  in  such  persons,  any  consider- 
able exertion,  without  having  first  taken  food,  after 
so  long  a  fast  as  usually  occurs  from  the  preceding 
meal,  is  unduly  exhausting  and  calculated  to  be 
injurious. 

The  unfed  organism  at  this  period  of  the  day  is 
also  very  susceptible  to  morbid  influences,  and  especi- 
ally prone  to  take  harm  from  exposure  to  cold,  to 
infection,  or  other  injurious  and  depressing  agencies. 

Of  coui-se,  for  those  who  prefer  to  take  a  substan- 
tial meal  at  noon,  or  a  little  earlier,  as  is  the  custom 
to  a  great  extent  on  the  Continent,  a  cup  of  good 
ca/e-au-lait,  with  a  little  bread  and  butter  or  dry  toast, 
or  biscuit,  taken  immediately  on  rising,  is  sufficiently 
stimulating   and   supporting  to   carry  one  over  the 


234  Food  in  Health.  {Part  i, 

interval  between  rising  and  the  midday  breakfast  or 
dejc.unur  a  la  fourchette. 

But  in  England  a  substantial  early  breakfast 
is  popular,  and  accords  well  with  the  business  and 
other  habits  of  average  Englishmen.  8  or  9  a.ni.  is 
the  usual  hour  for  this  meal.  The  quantity  and  kind 
of  food  proper  to  be  taken  at  this  meal  must  depend 
on  what  may  be  the  custom  with  regai'd  to  the  food 
taken  at  luncheon,  or  at  an  early  dinner.  Those  who 
take  a  substantial  meal  in  the  middle  of  the  day  do  not 
require  a  large  breakfast ;  a  cup  of  tea,  cofl'ee,  or  cocoa, 
with  a  little  bread  or  toast  and  butter,  a  boiled  or 
poached  egg  and  a  rasher  of  bacon,  is  ample  in  this  case. 
But  when  only  a  very  light  luncheon  is  taken  between 
breakfast  and  late  dinner — a  plan  which  suits  many 
busy  professional  and  business  men  exceedingly  well 
— then  the  breakfast  should  be  as  substantial  as  the 
appetite  and  digestion  are  equal  t.o.  A  little  well- 
made  oatmeal  porridge  to  begin  with,  then  some  fish 
such  as  sole,  whiting,  haddock,  a  fresh  or  kippered 
herring,  a  poached  or  lightly-boiled  egg,  with  a  little 
broiled  ham  or  bacon,  bread  and  butter,  or  dry  toast, 
and  marmalade,  or  some  fruit  compote  ;  tea,  coffee,  or 
cocoa. 

With  a  substantial  breakfast  such  as  this,  and  a 
good  vigorous  digestion,  the  organism  is  well  fur- 
nished to  begin  the  work  of  the  day,  and  only  a  very 
light  luncheon  will  be  required.  This  should  consist 
of  the  lean  of  a  small  mutton  chop,  or  a  little  cold 
chicken,  with  bread  or  a  potato,  or  a  small  basin  of 
good  soup  with  a  little  toast.  Nothing  more  !  Half- 
past  1  or  2  o'clock  is  a  good  time  for  such  a  meal. 

Those  who  take  a  light  breakfast,  and  find  it  con- 
venient practically  to  dine  in  the  middle  of  the  day, 
must,  if  they  are  engaged  in  active  intellectual  work 
in  the  afternoon,  be  careful  not  to  make  a  large  meal 
at  this  hour,  as  it  is  almost  certain  to  make  them 
heavy  and  dull  for  an  hour  or  two  afterwards. 

An  early  dinner  of  this  kind  should  consist  simply 
of  a  chop  or  steak,  or  a  cut  or  two  of  some  good  joint, 


Chap.  X.]     Different  Systems  of  j^eeding.      235 

hot  or  cold,  with  a  small  quantity  of  bread  and  vege- 
tables, a  little  bread  and  cheese,  or  butter ;  or,  if 
preferred,  a  little  light  pudding  or  some  cooked  fruit. 

The  widely-spread  custom  of  taking  a  cup  of  tea 
about  5  o'clock  is  consistent  with  either  of  the  above 
methods.  For  those  who  have  lunched  lightly,  it 
aflbrds  that  little  necessary  stimulus  and  support  to 
carry  them  on  to  the  dinner-time  ;  and  for  those  who 
have  dined  early,  it  favourably  influences  the  process 
of  digestion,  and  rouses  the  mental  and  physical 
energies  for  the  completion  of  the  day's  work. 

A  substantial  dinner  at  7  or  half-past  (it  should 
not  be  later)  is  appropriate  for  those  who  lunch  lightly. 
It  should  consist  of  soup  or  fish,  or  both,  an  entrde, 
or  some  joint,  poultry  or  game,  according  to  choice ; 
some  cooked  fruit  or  light  pudding,  biscuit  and  cheese, 
and  fresh  vegetables  and  salads  of  the  season. 

Those  who  take  an  early  dinner  should  take  a  light 
supper  about  half-past  8  or  9  :  a  little  white  fish,  or 
chicken  and  ham,  or  other  cold  meat  and  salad,  with 
a  little  bread  and  cheese  or  butter. 

Considerable  variations  in  the  manner,  frequency, 
and  time  of  taking  meals  appear  to  be  not  incon- 
sistent with  health  and  convenience. 

There  are,  as  Sir  Henry  Thompson  has  pointed  out, 
certainly  three  different  systems  extensively  practised. 

First,  there  is  the  Continental  system  of  two  meals 
a  day.  The  dejeuner  d,  la  fourchette — which  corre- 
sponds with  our  lunch  or  early  dinner — is  usually 
taken  between  11  a.m.  and  noon.  This  is  a  sub- 
stantial but  not  a  heavy  meal,  and  frequently  consists 
of  some  white  fish,  or  cutlets,  or  a  made  dish  of  some 
kind,  then  an  omelette  and  some  fruit  or  cheese. 
Wine  and  water  is  usually  drunk  with  this  meal.  The 
only  food  taken  before  this  meal  is  a  cup  of  cafe-ait- 
lait  or  chocolate,  with  a  little  bread  and  butter  or  a 
rusk,  which  is  served  in  one's  bedroom  on  first  getting 
up.  This  accords  perfectly  with  the  earlier  hours  of 
the  professional  classes  on  the  Continent.  Their 
work  begins  often  at  8  or  8.30  a.m.,  and  they  are  not 


236  Food  in  I/eaith.  Parti. 

delayed  by  a  formal  meal,  but  go  directly  from  their 
bedi'ooms  to  their  work. 

By  11.30  they  have  done  three  hours'  work,  and 
then  their  first  formal  meal  or  dejeuner  comes  as  an 
agreeable  break  or  rest  in  the  day's  labours.  They 
usually  take  plenty  of  time  over  this  meal ;  and  a 
cup  of  coffee  leisurely  sipped,  together  with  a  cigarette, 
occupies  the  following  half  hour.  The  second  meal  or 
dinner  is  taken  when  the  day's  work  is  over,  usually 
between  6  and  7  p.m.  This  is  a  substantial  meal  of 
SOU)),  fish,  one  or  two  moat  dishes,  sweets,  and  dessert ; 
black  coffee  follows.  Nothing  more  in  the  way  of 
solid  food  is  taken.  On  the  whole,  less  food  appears 
to  be  taken  in  this  way  than  on  the  English  system  ; 
more  attention,  is,  however,  paid  to  the  cooking,  and 
the  food  is  on  that  account  more  stimulating  and  sup- 
porting, and  less  oppressive.  What,  perhaps,  seems 
most  remarkable  to  an  Englishman,  in  this  system,  is 
that  it  is  adopted  by  all  classes  of  the  community  in 
France  and  elsewhere  on  the  Continent ;  whereas,  in 
Great  Britain  the  time  of  taking  food  is  almost  a  class 
distinction. 

Secondly,  there  is  the  system  prevalent  amongst 
a  large  part  of  the  middle  classes  in  England — Sir 
Henry  Thompson  calls  it  "  the  provincial  system" — of 
taking  four  meals  a  day.  It  is,  no  doubt,  adapted,  to 
some  extent,  to  their  earlier  hours  and  longer  day's 
work. 

The  first  meal,  or  breakfast,  is  taken  about  8  a.m., 
and  usually  consists  of  tea  or  coffee,  bread  and  butter, 
some  bacon,  or  salt  or  smoked  fish,  or  an  egg.  Dinner 
is  the  next  meal,  usually  at  1  or  half-past.  This 
commonly  consists  of  a  joint  and  plain  vegetables, 
some  pudding,  and  bread  and  cheese.  Soup  or  fish 
may  be  added  to  this  meal  on  occasions. 

Tea  follows  at  5  or  6.  This  is  not  infrequently 
made  a  somewhat  lieavy  meal — wjiat  is  called  a 
"  heavy  tea  " — and  is  the  great  defect  in  this  system. 
It  is  much  too  soon  after  the  substantial  midday 
dinner  for  another  substantial  meal,  and  these  "  heavy 


Chap.  X.]  Order  of  Meals,  etc.  237 

teas  "  are  responsible  for  a  great  deal  of  the  dyspepsia 
prevalent  amongst  this  class. 

There  would  be  no  harm  in  drinking  tea  at  this 
hour,  but  the  taking  of  solid  food  (except  with  young 
growing  girls  and  boys)  should  be  postponed  to  the 
next  meal  or  supper  at  8,  if  the  dinner  is  at  1  ;  at 
9  p.m.,  if  the  dinner  hour  is  2  o'clock. 

This  should  consist  of  a  moderate  meal  of  fish  or 
meat,  cold  or  hot,  with  bread  or  potatoes. 

This  system  of  four  meals  a  day  is  well  adapted  to 
young  growing  people  whose  digestions  are  active  and 
vigorous.  They  require  food  more  frequently,  and  in 
larger  quantities,  than  adults.  It  is  similar  also  to 
the  German  system ;  but  the  Germans  dine  almost 
universally  at  12  30,  not  later,  and  their  supper  is 
regularly  served  at  7.30  or  8  p.m. 

Thirdly,  there  is  the  system,  already  described, 
adopted  by  the  j)rofessional  and  upper  classes  of 
breakfast,  lunch,  and  late  dinner,  with  5  o'clock  tea. 
In  this  system  it  is  tlie  lunch  which  is  the  difficulty 
and  danger ;  it  should  be,  as  Sir  Henry  Thompson 
observes,  sufficient  to  support  activity,  not  so  consider- 
able as  to  impair  it.  Again  let  it  be  said,  that  .solid 
food  should  not  be  taken  with  the  5  o'clock  tea,  and 
it  is  better  not  to  take  either  sugar  or  cream  with  the 
tea  at  this  hour.  A  thin  slice  of  lemon  added  to  the 
cup  of  tea,  which  should  be  made  of  China  tea  of  good 
quality,  is  best.  Children  should  not  be  allowed  to 
partake  of  the  late  dinner  ;  the  four  meals  system  is,  as 
has  been  already  stated,  more  suitable  to  their  needs. 

The  order  of  the  courses  at  dinner,  i.e.  of  soup, 
fish,  entrde,  roast,  and  sweets,  cannot  well  be  improved 
upon.  Soup  at  the  bef/innhu/  of  dinner  has  been 
objected  to  on  the  ground  that  it  diminishes  digestive 
power  by  diluting  the  gastric  juice,  and  this  objection 
is  valid  if  a  large  quantity  of  badly -made  soup  is 
taken.  But  it  does  not  apply  to  a  small  quantity, 
4  to  8  oz.,  of  well-made  clear  soup.  Such  a  fluid 
disappears  quickly  on  reaching  the  stomach,  as  it  is 
rapidly  absorbed  by  its  bloorl  \^essels  and  interferes  in 


238  Food  in  Health.  [Parti. 

no  way  with  the  gastric  juice.  Its  value  at  the 
commencement  of  a  meal  depends  on  the  fact  of  its 
rapid  absorption  and  entrance  into  the  blood,  so  that 
the  hungry  man  is  quickly  refreshed.  "  Soup  intro- 
duces at  once  into  the  system  a  small  instalment  of 
ready-digested  food  and  saves  the  period  of  trial,  wdiich, 
in  the  absence  of  soup,  must  be  spent  by  the  stomach 
in  deriving  some  portion  of  nutriment  from  .solid  ali- 
ment, and  thus  tlie  organ  of  digestion  itself  is  indirectly 
strengthened  for  its  forthcoming  duties  ;  "  by  filling 
the  vessels  of  the  stomach  itself  it  really  assists  in  the 
secretion  of  the  gastric  juice.  A  certain  interval  should 
be  allowed  to  elapse  between  the  last  meal  of  the  day, 
whether  it  be  called  dinner  or  supper,  and  the  time  of 
going  to  bed.  The  functions  of  tlie  body  pass  into  a 
state  of  inactivity  during  sleep,  and  all  the  organs  of  the 
body  should  "  rest  from  their  labours,"  If  the  chief 
work  of  tlie  stomach  is  not  completed  or  nearly  com- 
pleted on  retiring  to  rest,  that  rest  is  likely  to  be 
imperfect  or  disturbed.  An  hour  and  a  half  or  two 
hours  is  sufficient  to  allow  between  a  light  supper  and 
bed  time,  but  at  least  two  and  a  half  or  three  hours 
should  elapse  between  a  heavy  dinner  and  retiring  to 
bed.  It  would  be  an  error,  however,  to  suppose  that 
a  perfectly  empty  stomach  contributes  to  repose  ;  on 
the  contrary,  it  frequently  is  the  cause  of  wakefulness. 
A  certain  sense  of  repletion,  a  sense  of  all  the  wants 
of  the  body  being  completely  satisfied,  conduces  greatly 
to  repose ;  this  is  strikingly  manifested  in  the  tendency 
shown  by  nearly  all  animals  to  fall  asleep  after  a  full 
meal.  Many  persons  who  of  necessity  retire  to  bed 
late,  and  who  do  not  dine  very  late  or  eat  very  largely 
at  dinner,  find  that  they  sleep  much  better  if  they  take 
a  breakfastcupful  of  clear  soup  with  a  little  toast  or 
the  same  quantity  of  arrowroot  before  going  to  bed. 

It  is  scarcely  necessary  to  say  that  the  habit  of 
taking  food  between  meals  or  other  than  at  the  stated 
meal  times  is  most  injudicious  and  hurtful. 

A  meal  should  not  be  commenced  immediately  after 
active  or    violent  exercise.       The  half-hour   devoted 


Chap.  X.]  Order  of  Meals,  etc.  239 

to  leisurely  dressing  for  dinner — and  after  violent 
exercise  half  an  hour's  perfect  rest  before  this  — is 
the  best  preparation  for  the  principal  meal  of  the 
day.  The  stomach  requires  to  have  at  its  disposal 
the  best  and  freshest  energies  of  the  body  for  its  im- 
portant work — the  work,  it  must  not  be  forgotten, 
upon  which  every  other  enerey  and  function  of  the 
body  is  absolutely  and  entirely  dependent.  For  the 
same  reason  violent  exercise  after  a  meal  is  to  be 
carefully  avoided. 

The  taking  of  strong  tea  and  strong  black  coffee 
after  dinner  should  be  avoided  by  those  who.se 
digestions  are  not  vigorous  ;  they  act  as  retarding 
agencies  and  tend  to  prolong  the  period  of  digestion, 
not  hasten  it ;  it  is  possible,  however,  as  Sir  W. 
Roberts  has  suggested,  that  the  slightly  retarding 
effect  they  exercise  on  digestion  may  not  be  altogether 
a  disadvantage  in  the  strong  and  vigorous.  A  cup  of 
hot  water  sipped  slowly  an  hour  or  two  after  dinner, 
instead  of  coffee  or  tea,  or  a  hot  and  veiy  weak 
infusion  of  the  latter,  will  sometimes  be  found  a 
material  aid  to  feeble  digestion. 


240 


CHAPTER  XL 

FOOD   IN    RELATION   TO    AGE   AND    CONDITION — FOOD    IN 

INFANCY     AND     CHILDHOOD FOOD     AT     SCHOOL 

FOOD    IN    ADULT    LIFE FOOD    IN    ADVANCED    AGE. 

In  considering  the  proper  relations  that  should  exist 
between  the  nature  and  amount  of  the  food  taken,  and 
the  age  of  the  individual  and  the  particular  conditions 
under  which  he  is  living,  we  shall  have  to  bear  in  mind 
that,  as  to  age,  there  are  three  great  and  principal 
divisions  in  human  life.  First,  the  age  of  growth 
and  development,  which  extends  from  birth  to  about 
eighteen  years  of  age,  and  this  we  shall  consider  as 
consisting  of  two  parts — (a)  the  period  of  infancy  and 
childhood,  terminating  at  the  tenth  year  of  life  ;  and  {h) 
the  period  of  school  life  or  adolescence.  It  is  especially 
characteristic  of  this  division  of  human  life  that,  while 
it  lasts,  the  individual  is  to  a  great  extent  dependent 
on  others  for  his  food  supply  and  its  selection — more 
so,  at  any  rate,  than  at  any  subsequent  period  of  his 
existence. 

Secondly,  there  is  the  period  of  adult  life,  the 
age  of  completed  growth  and  perfect  development; 
the  age  of  the  full  and  varied  employment  of  all 
the  functions,  physical  and  intellectual,  of  the 
organism.  It  will  be  convenient  to  consider  undei- 
this  division  the  influence,  in  relation  to  his  food,  of 
the  different  conditions  or  circumstances  of  life  to 
which  the  individual  may  be  subject. 

Thirdly,  there  is  the  period  of  advanced  age ;  the 
period  of  declining  powers  and  progressively  weaken- 
ing functions. 

According  to  the  investigations  of  what  is  called 
•*  The  Munich  School,"  the  following  table  gives  the 


Chap.  XI.1 


Food  in  Infancy. 


241 


minimum  amount  of  food  necessary  for  different  ages, 
stated  in  grammes  : — 


Age. 

Nitrogenous. 

Fat 

Carbo- 
hydrates. 

Child  under  18  months  ... 
„     from 6  to  15  years... 
Men  (moderate  work) 

"Women      

Old  Men 

,,    Women          

grammes. 

20  to  36 

70    ..    80 

118 

92 

100 

80 

gramme.s. 
30  to  45 
37    „    50 

56 

44 

68 

50 

grammes. 
60  to   90 
250    ,,400 

500 

400 

350 

260 

It  will  be  necessary  in  the  first  place  to  consider, 
and  to  consider  at  some  length,  on  account  of  its 
initial  Sind  intrinsic  importance,  the  subject  of 

Food   ill    iiirancy   and    childhood.  —  The 

feeding   of  infancy  may  be  dealt  with  under  three 
heads — 

1st.  When  the  babe  is  suckled  by  a  healthy 
mother  with  a  sufiicient  milk-supply. 

2nd.  When  it  is  entrusted  to  a  wet-nurse. 
3rd.  When  it  is  "  brought  up  by  hand  "  and 
has  to  be  fed  by  means  of  what  are  termed 
"  substitutes  for  mother's  milk." 

Ist.  When  an  infant  is  suckled  by  a  healthy 
mother,  its  food  for  the  first  seven  or  eight  months  of 
its  life  should  be  entirely  restricted  to  the  mother's 
milk.  This  is  the  only  food  that  is  perfectly  adapted, 
by  its  characters  and  composition,  to  the  digestive 
capacities  of  the  young  infant.  For  some  time  after 
birth  the  salivary  glands  are  not  developed  and  the 
pancreatic  secretion,  for  the  first  three  months,  has  no 
power  of  digesting  starch,  so  that  the  young  infant  is 
not  provided  with  any  means  of  digesting  farinaceous 
food,  even  in  small  quantities,  and  none  should  there- 
fore be  given.  At  birth  the  digestive  organs  are  in  a 
comparatively  immature  state,  the  alimentary  canal 
is  short  and  the  caicum  very  small. 


242  Food  in  Health.  iPaiti. 

It  usually  happens  that  ths  secretion  of  milk  in 
the  breasts  of  the  mother  is  not  fully  established  until 
the  third  day  after  the  birth  of  the  child ;  but  if  the 
babe  is  perseveringly  applied  to  the  breast  every  two 
hours,  while  the  mother  is  awake,  there  need  be  no 
fear  of  starvation. 

During  the  first  six  weeks  the  child  should  be 
put  to  the  breast  every  second  hour  from  5  a.m. 
to  11  p.m.  It  should  be  removed  from  the  breast 
as  soon  as  it  shows  an  inclination  to  discontinue 
sucking;  and  it  should  be  remembered  that  at 
birth  the  child's  stomach  is  of  very  small  capacity, 
and  the  breast  should  never  be  forced  upon  it, 
so  long  as  it  sleeps  well,  and  thrives  well,  and  is 
content. 

Feeding  every  three  hours  will  be  often  enough, 
with  many  children,  after  the  third  week,  and  up  to 
the  end  of  the  second  month.  It  must  be  remembered 
that  these,  as  well  as  the  periods  to  be  subsequently 
stated,  are  only  average  intervals,  useful  for  general 
guidance,  but  which  may  need  modification  according 
to  individual  peculiarities,  some  infants  feeding  much 
more  eagerly  than  others,  and  taking  more  at  a 
time.  From  the  second  to  the  seventh  or  eighth 
month  the  infant  should  be  suckled  every  three  or 
four  hours. 

The  composition  of  human  milk  varies  somewhat, 
according  to  the  period  of  lactation  and  other  circum- 
stances. After  delivery,  for  the  first  few  days,  it  is 
of  greater  consistence  and  of  a  yellow  colour,  and 
is  known  as  colostrum.  It  contains  large  cells  filled 
with  fat  granules  termed  colostrum  corpuscles.  The 
regular  secretion  of  milk  begins  after  three  or  four 
days.  The  casein  and  fat  increase  in  quantity  up  to 
the  end  of  the  second  month,  the  salts  up  to  the  fifth 
month,  and  the  sugar  from  the  eighth  to  the  tenth 
month.  The  greater  the  quantity  secreted,  the  more 
casein  and  sugar  and  the  less  fat  it  contains.  The 
milk  of  a  primipara  is  richest  in  solids. 

The    diet   of   the   mother,   no    doubt,    influences 


Chap.  XL]  Feeding  in  Infancy.  243 

somewhat  the  composition  of  the  milk,  especially 
as  to  the  amount  of  fat  it  may  contain.  It  should 
be  simple,  nutritious,  ample,  and  regular.  Rich  and 
stimulating  foods  should  be  avoided.  She  may  be 
permitted,  for  the  purpose  of  increasing  the  flow  of 
milk,  the  free  use  of  animal  broths,  chocolate,  milk, 
gruel,  and  sometimes  a  moderate  quantity  of  porter 
or  stout. 

Oatmeal  porridge  at  breakfast  is  excellent,  and 
tends  to  obviate  the  constipation  that  often  attends 
this  period  of  relative  physical  inactivity. 

"  Fortunate,"  says  an  American  writer,*  "  is  the 
babe  that,  in  our  day  of  advanced  civilisation  and 
city-living,  can  draw  from  the  breast  of  a  robust 
mother  an  abundant  supply  of  pure,  health-giving, 
tissue-building  food."  In  such  a  case  the  child 
should  be  nursed  solely  by  the  mother  up  to  eight 
months,  and  after  that  partially  to  the  end  of  the 
first  year,  if  possible. 

The  date  of  weaning  must  depend,  to  some  extent, 
on  the  health  of  the  mother  and  the  development  of 
the  child.  If  both  are  doing  well,  between  the  tenth 
and  the  twelfth  month,  the  breast  should  be  gradually 
withdrawn. 

After  the  seventh  or  eighth  month,  when  the 
teeth  begin  to  appear  and  the  salivary  glands  to 
be  developed,  some  other  food  may  be  introduced, 
once  or  twice  a  day,  instead  of  the  breast-milk.  The 
following  hav£  all  been  highly  recommended  :  — 

Chapman's  Entire-Wheat  Flour.  This  contains 
some  ''cerealin,"  which  has  the  property  of  converting 
starch  into  dextrin  and  maltose  ;  it  is  rich  also  in 
albuminates,  fats,  and  the  necessary  mineral  sub- 
stances, as  in  its  preparation  the  pollard  or  outer 
parts  of  the  grain  are  retained. 

Liebig's  Food,  Mellin's  Food,  Allen  and  Hanburys' 

Food,  Benger's  Food,  Savory  and  Moore's  Food,  and 

Nestle's    Food   are  all    appropriate,   as  they   contain 

starchy   matter   in  a    readily  assimilable  form,   with 

*  Dr.  Louis  Starr,  of  Philadelphia. 

Q2 


244  Food  in  Health.  [Parti. 

some  preparation  of  malt.  A  small  tablespoonful  of 
any  of  these  malted  foods  may  be  given  for  the  midday 
meal. 

Mutton  broth  or  jelly  made  from  the  shank  of 
mutton  is  also  admissible.  But  after  weaning,  and 
up  to  a  year  and  a  half,  milk  should  still  be  the  chief 
article  of  diet.  Cow's  milk,  with  about  one-fourth 
water,  or  the  following  mixture,  is  good  : — Cream, 
i  oz.  \  milk  (cow's),  4  oz. ;  sugar  of  milk,  a  dram  ;  and 
watei*,  \\  oz.  This  should  be  warmed  in  a  water 
bath.*  A  little  custard  pudding  may  also  be  given 
daily,  made  by  mixing  one  egg  with  half  a  pint  of 
milk,  and  adding  a  little  sugar. 

The  egg  usefully  supplies  a  certain  amount  of 
albuminates  and  fats. 

After  eighteen  months  the  following  aiticles  of 
diet  may  be  gradually  and  occasionally  introduced  : — 

A  little  finely  pounded  chicken,  mutton,  or  beef, 
and  especially  mutton _/«<,  which  may  be  pounded  and 
mixed  with  a  little  mealy  potato,  and  a  little  red  meat 
gravy  added  to  it. 

Mashed  potato  and  cauliflower  carefully  2)assed 
through  a  sieve  may  also  be  used,  as  well  as  stale 
bread-crumb,  soaked  in  milk  or  broth. 

As  soon  as  the  teeth  are  fully  developed  some 
food  requiring  mastication  should  be  given. 

The  foregoing  dietary  applies  to  a  healthy  child 
brought  up  by  a  healthy  mother  on  breast-milk.  But 
it  often  happens  that  the  mother's  milk  is  defective 
both  in  quality  and  quantity,  and  in  that  case  it  is 
necessary  to  change  it ;  or  it  may  be  defective  only  in 
quantity,  and  then  it  must  be  supplemented. 

2nd.  The  best  substitute  for  the  mother's  milk  is 
that  of  a  young  and  healthy  wet-nurse,  when  she  can 
be  obtained. 

As  to  the  qualities  of  a  wet-nurse  :  she  should  be 
robust  and  strong,  and  rather  spare  than  fat  ;    free 

*  "Whenever  the  milk  supply  is  not  wholly  beyond  the  possi- 
bility of  contamination,  the  milk  should  V)e  sterilised  by  boiling  or 
in  the  manner  to  be  subsequently  described. 


Chap.  XI.]      Qualities  OF  A    Wet-Nurse.  245 

from  all  inherited  tendency  to  mental  or  physical 
disease,  and  presenting  no  trace  of  syphilis,  tuber- 
cialosis,  or  scrofula.  She  should  be  cheerful,  good- 
natured,  active,  and  temperate ;  she  should  be  between 
twenty  and  thirty  years  of  age,  and  her  infant  should 
be  of  nearly  the  same  age  as  that  of  the  one  to 
be  suckled.  She  should  have  an  abundance  of  good 
milk,  the  best  test  of  which  will  be  the  aspect  of  her 
own  child. 

It  is  better,  if  possible,  that  she  should  be  a 
multipara,  as  she  is,  in  that  case,  more  likely  to 
understand  her  business  ;  but  there  is  no  objection 
to  a  primipara,  if  otherwise  eligible. 

It  has  been  said  that  it  is  wise  to  select  as  wet- 
nurse  a  woman  whose  infant  is  three  months  old,  as 
her  milk  is  then  of  uniform  quality,  and  there  is  then 
time  to  see  if  there  is  any  syphilis  in  the  infant  or 
mother. 

If  the  milk  of  the  wet-nurse  is  found  to  disagree 
with  the  infant,  it  may  be  necessary  to  change  the 
nurse ;  the  diet  of  the  wet-nurse  should,  howevei*,  be 
first  carefully  investigated. 

Milk  of  good  quality  is  secured  by  proper  food, 
but  wet-nurses  are  usually  and  unwisely  overfed  with 
butcher's  meat,  and  ale  and  porter,  and  are  in  the 
habit  of  taking  far  too  little  exercise.  Their  health  is 
liable  to  suffer  from  a  rich  and  an  over-albuminous 
diet,  especially  as  they  have  probably  been  underfed 
in  their  immediately  antecedent  life.  A  diet  should 
be  given  them  more  in  accordance  with  that  to  which 
they  have  become  habituated. 

Dr.  W.  J.  Thayer,  of  Brooklyn,  New  York,  ofTers 
a  valuable  suggestion  as  to  the  food  most  appropriate 
to  the  expectant  mother.  "  Early  in  gestation  she 
should  begin  to  eat,  at  least  three  times  a  day,  some 
form  of  coarse  cereal  foods,  such  as  oatmeal,  Graham, 
rye,  or  Indian  breads.  These  articles,  being  made  from 
the  unboiled  products  of  the  grains  used,  contain  a 
much  larger  proportion  of  lime  salts  than  the  prepara- 
tions of  the  tine  bolted  flour  of  ordinary  employment. 


246  Food  in  Health.  [Parti. 

The  result  is  that  the  mother  supplies  her  offspring, 
first  through  the  umbilical  cord,  and  afterwards 
through  the  mammary  glands,  with  a  pabulum  con- 
taining essential  elements  for  the  nutrition  of  a  very 
important  set  of  organs,  namely,  the  teeth."  This 
should  be  supplied  from  the  commencement  of  the 
development  of  the  teeth,  i.e.  about  the  sixth  week 
of  intra-uterine  life. 

3rd.  Other  "  substitutes  "  for  mother's  milk  and 
bringing  up  "  by  hand  "  must  next  be  considered.  On 
this  the  Amei-ican  author  already  quoted*  observes : 
"  There  can  be  no  doubt,  though  the  statement  is  a 
bold  one,  and  seemingly  contrary  to  nature,  that, 
taking  the  average,  infants  properly  brought  up  by 
hand  are  better  developed  and  enjoy  more  perfect 
health  than  those  completely  breast-fed.  Of  coui^se, 
there  is  no  artificial  food  equal  to  the  natural — the 
sound  breast-milk  of  a  robust  woman — and  a  child  fed 
upon  this  must  thrive,  if  other  circumstances  are 
favourable.  Unfortunately  the  woman  who  has  suffi- 
cient health  and  strength  to  furnish  an  abundant 
supply  of  good  milk  during  the  ten  or  twelve  months 
of  normal  lactation  is  unique  in  our  day  "  (he  is  speak- 
ing oi  American  women),  "and  the  great  bulk  of  those 
who  do  nurse  children,  grow  pale,  thin,  and  feeble, 
and  give  milk  which,  though  sufficient  in  quantity  to 
fill  the  suckling's  stomach  and  satisfy  the  craving  of 
hunger,  does  not  contain  enough  pabulum  to  meet  the 
demands  of  nutrition.  Such  mothers  always  complain 
that  their  children  are  puny,  peevish,  and  always 
ailing,  and  wonder  why  their  neighbour's  babies  fed 
upon  the  bottle  are  so  round,  jolly,  and  healthy.  The 
explanation  lies  in  the  simple  fact  that  good  cow's 
milk  is  better  than  bad  breast  milk  ! " 

Besides  cow's  milk,  a.ss's  milk  and  goat's  milk  have 
been  proposed  as  substitutes  for  mother's  milk. 

Ass's  milk  is  a  good  substitute  ;  it  has  a  very  fine 
curd,  and  is  easy  of  digestion,  but  it  is  costly,  and, 
compared  with  human  milk,  is  defective  in  albuminates 
•  Dr  Louis  Stjur. 


Chap.  XI.]   Substitutes  for  Mother's  Milk.     247 

and  fats,  as  will  be  seen  in  the  table  on  page  248,  and 
it  would  require  nearly  twice  the  quantity  of  ass's 
milk  to  supply  the  nutriment  contained  in  human 
milk.  It  has  also  laxative  properties.  Goat's  milk  is 
richer  in  albuminates  and  fats  than  human  milk,  and 
even  than  cow's  milk,  and  it  has  also  a  strong  and 
peculiar  odour,  but  infants  do  not  seem  to  object  to 
this.  One  of  the  advantages  of  goat's  milk  is  that  the 
animal  yielding  the  milk  can  be  kept  on  the  premises, 
and  its  health  and  feeding  carefully  superintended, 
and  it  can  be  trained  so  that  the  infant  can  suck  the 
milk  directly  from  the  udder. 

Either  of  these  milks  may  be  boiled,  and  this 
process  removes  the  strong  odour  of  goat's  milk  and 
the  laxative  property  of  ass's  milk. 

The  reason  why  the  milk  of  the  ass  and  even  that 
of  the  goat  will  agree  with  the  human  infant  when 
cow's  milk  disagrees,  would  appear  to  be  owing  to 
their  different  manner  of  clotting  when  they  come 
into  contact  with  the  gastric  juice. 

Cow's  milk  has  a  tendency  to  coagulate  in  the 
infant's  stomach  into  large,  firm,  cheese-like  masses, 
which  are  apt  to  cause  much  gastro-intestinal  irri- 
tation, whereas  ass's  and  goat's*  milk  form  a  loose 
flocculent  curd  like  human  milk. 

But  in  the  vast  majority  of  instances  it  is  upon 
cow's  milk  we  must  rely  as  a  substitute  for  mother's 
milk  ;  it  has  the  enormous  advantage  of  being  plentiful 
and  cheap,  and  its  defects  can,  with  a  certain  amount 
of  care,  be  easily  remedied.  Moreover,  if  the  cow's 
milk  is  boiled  as  soon  as  received  this  not  only 
sterilises  it  but  rendei-s  it  more  easy  of  digestion,!  as 
the  curd  coagulates  in  somewhat  smaller  masses,  and 
it  is  less  liable  to  ferment. 

A  comparative  study,  therefore,  of  human  and 
cow's  milk  is  an  important  duty  in  connection  with 
infant    feeding.     It    must    be    borne   in    mind,    as 

*  This  is  dollied  by  Cheadle,  so  far  as  goat's  milk  is  concerned. 
("Feeding  of  Infants,"  3rd  edit.,  p.  6.) 

+  This  is  doubted  by  some  authorities. 


248 


Food  in  Health. 


[Part  I. 


has  already  been  pointed  out,  that  mother's  milk 
varies  in  composition  at  different  periods  of  lacta- 
tion, and  in  different  individuals,  so  that  consider- 
able discrepancies  may  be  discovered  in  the  pub- 
lished analyses.  The  nitrogenous  constituents  are  the 
most  changeable,  and  may  vary  in  different  specimens 
from  4-86  to  0-85  per  cent.,  next  the  fats,  and  next 
the  salts,  the  maximum  being  about  three  times  the 
minimum.  The  sugar  is  the  least  variable  consti- 
tuent, and  contains  a  nearly  uniform  standard  of  7 
per  cent. 

The  following  table  gives  the  normal  composition 
of  human,*  cow's,  and  ass's  milk.  The  third  column 
gives  Luff's  recent  analysis  of  human  milk,  which 
differs  considerably  from  some  others.  Doubtless  the 
composition  of  different  specimens  varies  greatly 
(see  p.  54). 


, 

Human 

MilU. 

(Average. ) 

Cow's 

Milk. 

(Average.) 

Human 

Milk. 

(LufTs 

Analysis.) 

Ass's 
Milk. 

Water 

Total  Solids    

per  cent. 

86-766 

13-234 

per  cent. 
87-7 
12-3 

8-48 

3-75 
4-42 
3-42 
0-64 

per  c-eut. 
88-51 

2-41 
6-39 
2-35 
0-34 

pcT  cent. 
90-5 

„         (not  fat)  ... 

9-221 

Fat       

Lactose            

Albuminoids   ... 

Ash       

4-013 
6-997 
2-058 
0-21 

1-4 

6-4 
1-7 

The  specific  gravity  of  human  milk  is  about  1031, 
and  its  reaction  is  persistently  alkaline ;  that  of  cow's 
milk  is  on  an  average  1029,  and  it  has  a  highly  acid 
reaction  if  not  quite  fresh  from  pasture-fed  cows.  It 
is  richer-looking,  whiter,  and  more  opaque  than  human 
milk.     A  further  very  important  difference  is  that  its 

•  Cheadle's  "Feeding  of  Infants, '  3rd  edit.,  p.  19. 


Chap.  XI.)    Substitutes  for  Human  Milk.         249 

nitrogenous  constituents  are  differently  affected  by 
coagulating  agents.  According  to  Konig,  the  total 
amount  of  albuminoids  in  cow's  milk  which  is  coagu- 
lated by  acids  is  far  greater — perhaps  four  times 
greatex' — than  the  non-coagulable  portion.  In  human 
milk  the  reverse  is  the  case,  and  the  non-coagulable 
portion  much  exceeds,  is  perhaps  twice  as  great  as, 
the  coagulable  part.  Again,  with  rennet  cow's  milk 
coagulates  into  large  firm  masses  ;  with  human  milk  it 
forms  a  light  loose  curd.  The  acid  gastric  juice  in  the 
stomach  has  the  same  effect,  producing  in  the  case 
of  cow's  milk  a  coagulum  most  difficult  to  digest,  and 
in  the  case  of  human  milk  one  which  is  readily 
attacked  and  broken  down  by  the  gastro-intestinal 
solvents. 

All  artificial  food  should  conform  as  closely  as 
possible  to  human  milk,  and  should,  like  it,  clot  in 
fine  flakes.  If  cow's  milk  is  used,  its  chemical  compo- 
sition and  physical  properties  must  be  modified  in 
order  to  make  it  a  fit  substitute  for  mother's  milk. 
The  albuminates  and  fats  are  largely  in  excess  in  the 
infant's  diet  as  compared  with  the  diet  of  adults,  and 
this  is  necessary  in  order  to  minister  to  the  very  lapid 
growth  which  takes  place  in  infancy  and  childhood, 
and  food  has  also,  on  this  account,  to  be  taken  more 
frequently.  The  brain  is  .said  nearly  to  double  its 
weight  in  seven  years.  The  liver  is  notably  larger  in 
childhood,  on  account  of  the  greater  activity  of  its 
metabolic  functions. 

]\Iuch  difference  of  opinion  exists  as  to  the  suit- 
a\>ility  of  "condensed  "milk  as  a  substitute  for  human 
milk.  It  certainly  has  the  advantage  of  keeping  V)etter 
than  ordinary  cow's  milk,  and  it  is  said  by  some  to  be 
moie  readily  digested  by  young  infants,  and  tliat  they 
thrive  on  it.  Others  assert  that  this  is  a  delusion, 
founded  on  the  cii-cumstance  that  condensed  njilk  is 
largely  diluted  with  water,  and  cow's  milk  not  suffi- 
ciently ;  that  the  infant  appears  to  thi'ive  because  con- 
densed milk  contains  a  large  proportion  of  added 
suijar,  which  forms  fat  and  makes   larijo  babies,  and 


25° 


Food  in  Health. 


[Part  I. 


also  counteracts  the  tendency  to  constipation,  but  that 
it  does  not  contain  enough  nutrient  constituents  to 
supply  the  wants  of  a  growing  infant. 

In  the  following  table  A.  Y.  Meigs  has  compared 
the  composition  of  condensed  milk  diluted  in  the  pro- 
portion usual  for  the  first  week  or  so  of  infant  life, 
with  some  average  specimens  of  human  and  cow's 
milk  : — 


Human 
Milk. 

Cow's  Milk. 

Ciinden.sed 

Milk  (Eagle 

Brand). 

Mixture  of  1 
Part  of  Con- 
densed Milk 
with  24  of 
Water. 

Water       ... 

87-163 

87-012 

27-942 

92-673 

Fat 

4-283 

4-209 

10-335 

1  -095 

Casein 

1-046 

3-222 

9-522 

•868 

Sugar 

7-407 

5-000 

50-861 

5-206 

Ash 

•101 

•527 

1  -.340 

•158 

It  will  be  seen  that  the  amount  of  fat  and  of 
casein  are  much  less  than  in  either  human  or  cow's 
milk,  and  that  of  sugar  less  than  in  human  milk. 
"The  addition  of  a  larger  proportion  of  condensed 
milk  would  remove  these  faults,  but  at  the  same  time 
would  increase  the  quantity  of  sugar  to  a  point  incom- 
patible with  perfect  digestion.  Again,  more  than  one- 
lialf  of  the  saccharine  ingredient  of  this  preparation  is 
cane-sugar,  added  for  the  purpose  of  preservation,  and 
this  material  is  very  liable,  when  in  excess,  to  ferment 
in  the  alimentary  canal,  giving  rise  to  irritant  products 
that  impede  digestion.  .  .  .  Infants  fed  upon  condensed 
milk,  though  fat,  are  pale,  lethargic,  and  flabby ; 
although  large  are  far  from  stiong ;  have  little 
power  to  resist  disease  ;  cut  theii-  teeth  late ;  and  are 
very  likely  to  drift  into  rickets  before  the  end  of  the 
first  year."  This  is  the  opinion  of  Dr.  Louis  Starr,  of 
Philadelphia,  who  concludes  that  it  is  never  safe  to 
bring  up  a  child  solely  on  this  food,  but  that  it  may 


Chap.  XL]  Condensed  Milk.  251 

be  used  occasionally  as  a  convenience,  such  as  in 
travelling,  etc. 

This  view  of  the  value  of  condensed  milk 
appears  to  be  shared  by  such  authorities  as  Dr. 
Eustace  Smith  and  Dr.  Angel  JNIoney.  Ashby  and 
Wright,  however,  in  their  work  on  the  "  Diseases 
of  Children,"  express  a  doubt  as  to  the  value  of  the 
evidence  brought  against  the  use  of  condensed  milk  ; 
they  have  seen  many  unquestionably  healthy  children 
brought  up  on  it  from  birth.  Cheadle  also  asserts 
that  "  if  properly  diluted  it  is  more  digestible  than 
fresh  unboiled  cow's  milk "  ;  it  is  undoubtedly  con- 
venient ;  it  does  not  readily  turn  sour,  and  it  may 
often  be  substituted  with  good  effect  for  fresh  cow's 
milk  when  the  latter  disagrees  and  causes  vomiting, 
or  at  those  times  when  cows  are  being  fed  on  tui'uips 
or  other  watery  food,  or  during  hot  weather,  when 
milk  is  apt  to  turn  sour. 

The  deficiency  in  casein  may  be  compensated  for 
by  the  addition  of  a  little  white  of  egg,  or,  better,  of 
raw  meat  juice,  half  a  teaspoonful  of  either  to  every 
other  meal,  and  the  addition  of  a  little  cream  will 
supply  the  deficiency  in  fat. 

We  have  received  strong  testimony  in  support  of 
this  favourable  view  of  the  use  of  condensed  milk 
as  a  substitute  for  breast-milk,  especially  when  the 
'■'unsweetened"  kinds  are  used,  such  as  Loeflund's. 

Cheadle  thinks  there  may  be  a  deficiency  of 
anti-scorbutic  elements  in  condensed  milk ;  but 
this  would  be  supplied  by  the  addition  of  raw  meat 
juice. 

FarinaceoKs  foods  are  never  admissible  before  the 
foui'th  month,  and  rarely  advisable  until  after  the 
seventh.  It  must  not  be  forgotten  that  they  differ 
widely  in  composition  from  human  milk.  In  arrow- 
root, which  is  one  of  the  most  digestible,  the  pro- 
portion of  albuminates  to  carbo-hydrates  is  ai!  1  to  20  ; 
whereas  in  human  milk  it  is  as  1  to  5.  Moreover, 
•the  starch  has  to  be  converted  into  sugar  befdre  it  can 
be  absorbed,  and  the  digestive  secretions  which  effect 


252  Food  in  Health.  [Parti. 

this  conversion  are  not  fully  established  until  the 
fourth  month. 

The  so-called  "infants'  foods"*  usually  contain 
some  malted  farinaceous  substance,  and  they  are  of 
value  as  additions  to,  not  as  substitutes  for,  milk. 
Their  nutrient  value  has  not  been  perfectly  deter- 
mined ;  but  they  are  especially  useful  as  "  mechanical 
attenuants,"  and  as  such  tend  to  prevent  the  coagu- 
lation of  cow's  milk  into  firm,  indigestible  curd. 
They  have  also  a  food  value  of  their  own,  rendering 
them  more  serviceable  than  the  starches,  as  they  not 
only  contain  a  pre-digested  carbo-hydrate  (dextrin, 
maltose,  and  grape  sugar),  but  also  some  vegetable 
proteid. 

Another  important  point  is  the  quantity  of  food 
that  should  be  given  to  an  infant  brought  up  by  hand. 
It  must  of  course  vary  with  the  age  and  appetite  of 
the  child,  and  it  must  be  remembered  that  too  fre- 
quent feeding  is  liable  to  set  up  gastro-intestinal 
catarrh.  A  good  practical  rule  is  to  let  the  infant 
take  as  much  or  as  little  as  it  likes,  provided  it 
thrives  ! 

Infants,  as  a  rule,  are  overfed  in  quantity.  Rotch 
has  ascertained  by  actual  measurement  that  the 
stomach  of  an  infant  five  days  old  contains  only  6J 
fluid  drams.  At  the  end  of  the  fourth  week  it  is  one 
and  a  half  times  or  twice  as  large.  By  the  end  of 
the  eighth  week  it  is  3^  times  as  large.  This  rapid 
increase  in  size  corresponds  with  the  rapid  growth  of 
the  first  two  months.  At  the  end  of  the  twelfth  week 
it  is  3^  times  as  large,  at  the  end  of  the  sixteenth 
week  3f,  and  at  the  end  of  the  twentieth  week  3^ ;  so 
that  during  the  third,  fourth,  and  fifth  months  the  in- 
crease is  slight.    The  quantity  of  food  should  be  rapidly 

*  "  Liebig's  food  for  infants  is  composed  of  equal  parts  of 
wheaten  flour  and  malt  flour  mixed  with  a  little  potassium  car- 
bonate, and  cooked  with  ten  parts  of  milk.  The  wheat  and  malt 
flour  are  usually  cooked  and  sold  in  powder  ready  to  be  boiled  with 
the  milk."  (Parkes.)  The  exposure  of  this  mixture  to  a  certain 
heat  is  attended  with  the  conversion  of  the  starch  into,  first, 
dextrin,  then  maltose,  and  finally  grape  sngar. 


Chap.  XI.]      Rules  for  Infant  Feeding.  253 

augmented  during  the  first  six  or  eight  weeks,  and 
then  kept  at  about  the  same  quantity  up  to  the  fifth 
or  sixtli  month.  There  is  another  considerable  increase 
between  the  sixth  and  tenth  months.  "The  greater 
the  infant's  weight  the  larger  the  gastric  capacity."* 
Assuming  the  average  initial  weight  to  be  from  6  to  81b, , 
it  is  estimated  that  during  the  first  five  or  six  months 
tlie  infant  will  gain  from  3|-  to  4  oz.  weekly  (Louis 
Starr  says  1  oz.  per  diem),  and  at  tlie  end  of  the  sixth 
month  will  weigh  about  IG  lb.,  or  double  his  initial 
weight. 

The  next  three  months  he  will  gain  on  an  average 
from  3  to  3i  oz.  weekly,  and  by  the  end  of  the  ninth 
month  should  weigh  about  20  lb.  During  the  re- 
mainder of  the  first  year  he  will  gain  from  \\  to  2  oz. 
a  week,  and  at  the  end  of  the  year  usuidly  weighs 
over  22  lb. 

The  following  is  considered  an  excellent  rule  for 
the  earlier  weeks  of  infant  feeding,  viz.  one  hundredth 
of  the  initial  V)od3'-weight  should  be  taken  as  the 
starting  quantity  of  food  for  each  meal,  and  to  this 
should  be  added  1  gramme  (fifteen  minims)  for  each 
day  of  life.  For  instance,  if  the  initial  weiglit  is  300 
grammes  (G  lb.),  then  30  graiinnes  (about  I  oz.)  should 
be  given  at  a  meal ;  at  fifteen  days  it  would  have 
increased  to  30  +  15  grammes  or  45  grammes  (about 
\\  oz.),  and  at  eighty  days  to  30  -f  30  or  60  grammes 
(about  2  oz.). 

Ashby  and  Wright  estimate  5  oz.  of  good  cow's 
milk  (of  course,  properly  diluted  and  prepared)  to  be 
sufficient  daily  for  the  first  two  or  three  weeks. 
Starr  calculates  for  the  first  four  weeks  an  allowance 
of  \i\  to  16  oz.  of  food  daily  ;  24  oz.  for  the  second 
and  third  month ;  2  to  2^^  or  3  pints  from  the  third 
to  the  twelfth  month.  Cheadle's  estimate  is  rather 
greater.  Ashby  and  Wright  consider  1^  to  2  pints 
daily  sufficient  between  six  and  twelve  months. 

After  this  period  it  is  advisable  rather  to  increase 
the  strength  of  the  food  than  the  quantity. 
Sonitkiu,  of  St.  Petersburji. 


254 


Food  in  Health. 


[Part  1. 


Dr.    Louis  Starr  gives  the   following  table  as  a 
guide  : — 

General  Rules  fob.  Feeding. 


Age. 

Intervals  of 
Feeding. 

Average 

Amount  at 

each 

Feeding. 

Average 
Amount  in 
24  Hours. 

Ist  week 

2   hours 

1  oz. 

10  oz. 

Ist  to  6th  weeks 

2i      „ 

Hto2  „ 

12  to  16  „ 

6th  to   12th  weeks,   and  ) 
possibly  to  5th  or  6th  \ 
months ) 

3        „ 

3  to  4  „ 

18  to  24  „ 

At  6  months       

3        „ 

6  ,. 

36  „ 

At  10  months      

3 

8  „ 

40   „ 

The  next  point  to  be  considered  is  the  method  of 
preparing  the  food,  the  object  being  to  make  cow's 
milk  resemble  human  milk  as  closely  as  possible  in 
chemical  composition  and  physical  properties.  In 
order  to  effect  this  we  must  reduce  the  proportion  of 
casein,  and  increase  the  proportions  of  fat  and  s\igar ; 
we  must  also  remove  the  tendency  of  the  casein  to 
coagulate  in  the  stomach  into  large,  firm,  indigestible 
masses. 

By  dilution  with  water  the  casein  may  be  brought 
to  the  proper  level,  and  by  the  addition  of  cream  and 
sugar  of  milk  in  proper  amounts  we  can  restore  the 
level  of  these  constituents.  Sugar  of  milk  has  the 
advantage  of  not  having  the  same  tendency  as  cane- 
sugar,  to  acetous  fermentation,  and  it  also  contains 
some  of  the  salts  of  milk.     Ashbv  and  Wiight  lla^"c, 


Chap.  XI.]         Artificial  Human  Milk.  255 

however,  failed  to  satisfy  themselves  that  milk-sugar 
is  in  any  way  superior  to  cane-sugar,  while  they  com- 
plain that  it  is  expensive,  and  tends  to  pass  into 
lactic  acid.* 

Frankland  has  suggested  the  preparation  of  arti- 
ficial human  milk  from  cow's  milk  by  the  following 
method : — Allow  i  of  a  pint  of  new  milk  to  stand 
twelve  hours,  remove  the  cream,  and  mix  it  with  f 
of  a  pint  of  perfectly  fresh  cow's  milk.  Take  the 
milk  from  which  the  cream  was  removed,  and  put  a 
piece  of  rennet  about  an  inch  square  (fluid  rennet 
may  be  employed)  into  it.  Keep  the  vessel  containing 
it  in  a  warm  place,  until  the  milk  is  fully  curdled,  an 
operation  requiring  five  to  fifteen  minutes,  according  to 
the  activity  of  the  rennet,  which  should  be  removed  as 
soon  as  the  curdling  commences,  and  put  into  an  egg- 
cup  for  use  on  subsequent  occasions,  as  it  may  be 
employed  daily  for  a  month  or  two.  Break  up  the 
curd  repeatedly,  and  carefully  separate  the  whole  of 
the  whey,  which  should  then  be  rapidly  heated  to 
boiling  in  a  small  tin  pan  placed  over  a  sjjirit-  or  gas- 
lamj).  During  the  heating  a  further  quantity  of 
casein,  technically  called  "  tieeting.s,"  separates,  and 
must  be  removed  by  straining  through  clean  muslin. 
Now  dis.solve  110  grains  of  powdered  sugar  of  milk  in 
the  hot  whey,  and  mix  it  with  the  g  of  a  pint  of  new 
milk  to  which  the  cream  from  the  other  fluid  has 
been  added  as  already  described.  The  artificial  milk 
should  be  used  within  twelve  hours  of  its  preparation.! 

In  order  to  prevent  the  firm  clotting  to  which 
cow's  milk  is  prone,  some  alkaline  solution  may  be 
added,  or  some  prefer  to  use  a  small  quantity  of  a 
mucilaginous  or  other  thickening  substance,  such  as 
barley-water,  a  solution  of  gelatin,  or  one  of  the  pre- 
pared foods,  which  acts  mechanically  in  obviating  the 
formation  of  firm  clots. 

*  "  Diseases  of  Children." 

+  Cheadle  considers  that  a  mixture  of  2  parts  cow's  milk  with 
1  of  water  and  3J  per  cent,  of  added  sugar,  "satisfies  all  the 
es&cutial  conditions.  '    ("Feeding  of  Infants,"  p.  54.) 


256  Food  in  Health.  [Parti. 

When  lime-watei'*  is  used  for  this  purpose,  it  acts 
by  partly  neutralising  the  acid  of  the  gastric  juice,  so 
that  the  casein  is  coagulated  gradually  in  small  masses, 
01'  passes  on  into  the  small  intestine  where  the  secre- 
tions are  alkaline.  It  must  be  in  the  proportion 
of  1  to  2  of  the  milk  mixture. 

Or  a  solution  of  bicarbonate  of  soda  may  be 
used,  about  6  grains  to  an  ounce  of  water,  or  an 
equivalent  quantity  of  the  saccharated  solution  of 
lime.  Thickening  substances  or  attenuants  act 
purely  mechanically  by,  as  it  were,  getting  between 
the  particles  of  casein  during  coagulation,  and  so 
preventing  their  running  together  and  forming  large 
compact  masses. 

The  best  for  this  purpose  is  barley-water  or 
"  barley-jelly."  It  may  be  used  in  the  same  propor- 
tions as  water. 

Or  a  solution  of  isinglass  or  gelatin  may  be  used. 
To  make  this,  put  about  an  inch  square  of  plate 
gelatin  into  half  a  tumblerful  of  cold  water,  and  let 
it  stand  for  three  hours ;  turn  the  whole  into  a  tea- 
cup, and  put  this  into  a  saucepan  half  full  of  water, 
and  boil  until  the  gelatin  is  dissolved.  When  cold 
this  forms  a  jelly,  of  which  one  or  two  teaspoonfuls 
may  be  added  to  each  bottle  of  food.  Or  Mellin's 
Food  may  be  used ;  in  this  the  starch  has  been  con- 
verted into  dextrin  and  maltose ;  a  teaspoouful  dis- 
solved in  a  tablespoonful  of  hot  water  when  added 
to  each  portion  of  food  makes  a  very  easily  digested 
mixture. 

Dr.  Stowell's  recent  experimentsf  showed  that 
simple  dilution  had  a  marked  effect  "  in  lessening 
the  size  of  the  clots  of  cow's  milk  formed  in  the 
stomach;"  but  the  addition  of  foreign  material  did 

*  Lime-water  is  easily  made  at  home  for  nursery  use  by  taking 
a  piece  of  unslaked  lime  the  size  of  a  walnut,  and  putting  it  into 
two  quarts  of  filtered  water  in  an  earthen  vessel,  and  stirring  it 
up  thoroughly  ;  allow  it  to  settle,  and  pour  off  the  clear  solution 
as  required  for  use,  replacing  with  water  and  stirring  up  as 
zonsumed. 

t  Australian  Medical  Joui-nal,  August  15,  1893. 


Chap.  XI.]       Schedule  of  Infant-Feeding.         257 

not    attenuate   the   size   of   the   clot   to   the   extent 
generally  supposed. 

A  schedule  has  been  drawn  up  by  Dr.  Louis 
Starr  of  the  diet  of  an  infant  from  birth  upwards.  It 
may  serve  as  a  useful  guide  : — 

Diet  During  Fir.st  Week. 

Tor  each  Feeding. 

Cream      2  fluid  drams. 

Whey      3     „ 

Water  (Hot)       3      „ 

Milk-sugar  10  grains. 

To  be  given  every  2  hours  from  5  a.m.  to  11  p.m.,  and 
once  or  twice  during  the  night  if  necessary.  This  will  give 
12  oz.  of  food  per  diem. 

To  make  the  whey,  take  half  a  pint  of  fresh  milk 
heated  to  about  140°  or  150°  F.,  and  1^  teaspoonful 
of  wine  of  pepsin,  or  one  teaspoonful  of  Fairchild's 
essence  of  pepsin,  and  stir  just  enough  to  mix.  Let 
the  mixture  stand  in  a  warm  place  until  firm  coagu- 
lation has  taken  place.  Next  beat  up  the  curd  until 
it  is  finely  divided  and  strain.  Whey  contains. in 
solution  the  sugar  and  the  salts  of  the  milk,  and  holds 
also  in  suspension  a  considerable  portion  of  casein  and 
fat,  which  passes  through  the  strainer. 

During  the  same  period  Dr.  Angel  Money*  re- 
commends \  an  oz.  of  thin  barley-water  with  \  an  oz. 
of  cow's  milk  and  15  grains  of  milk-sugar,  to  be  given 
every  two  houi-s,  night  and  day. 

DiBT   PROM   THE   SECOND   TO   THE   SiXTH    WeEK. 

For  each  Feeding. 


Milk  (Cow'b) 
Cream 

Milk-sugar  .. 
Water 


^  fluid  oz. 

..     16  grains. 
1  fluid  oz. 


To  he  given  every  2  hours  from  .5  a.m.  to  11  p.m.  =  17  o»i. 
per  diem. 

*  "  Treatment  of  IHseases  of  Children." 


258  Food  in  Health.  [Parti. 

Diet  from  the   Sixth  Week  to   the  End   op  the  Second 
Month. 

For  each  Feeding. 

Milk  (Cow's)  1^  fluid  oz. 

Cream           ...  ...         ...         ...         \       „ 

Sugar  of  Milk  30  grains. 

Water  ...         1|  fluid  oz. 

To  be  given  every  2  hours  ^  30  oz.  per  diem. 

Dr.  Angel  Money's  diet  i.s — cow's  milk,  9  drams  ; 
barley-water,  \  oz.  ;  cream,  2  drams ;  milk-sugar,  30 
grains;  and  water,  3  drams;  every  2i  liours. 

Diet   from  the   Begixnino  of  the  Thiiu)   Month   to   the 
Sixth  Month. 

For  each  Feeding. 

Milk  (Cow's)         2Joz. 

Cream         ...         \  ,, 

Sugar  of  Milk       ...         ...         ...         ...  60  grains. 

Water         1  oz. 

To  be  given  every  1\  hours  =  32  oz.  per  diem. 

Diet  during  Sixth  Month. 

Six  meals  daily,  from  6  or  7  a.m.  to  9  or  10  p.m. 

Morning  and  midday  bottles,  each. 

Milk  (Cow's)         4ioz. 

Cream        i  ,, 

Mellin's  Food       60  grains. 

Hot  Water            ...         ...  1  oz. 

Dis.solve  the  Mellin's  Food  in  the  hot  water  and  add,  with 
stirring,  to  the  previously  mixed  milk  and  cream. 


The  other  bottles,  each. 

Milk  

Cream 

Sugar  of  Milk 
Water        

Making  a  total  of  36  oz.  of  food  per  diem. 


4|oz. 

a    »> 

60  grains. 
1  oz. 


For  this  month  Dr.  Angel  Money's  diet  consists  of 
cow's  milk,  2J  oz. ;  barley  water,  |  oz. ;  cream,  5 
drams ;  milk-sugar,  60  grains  ;  and  water,  1^  oz.  every 
3  hours. 


Chap.  XI.]       Schedule  OF  Infant-Feeding.         259 

In  the  seventh  month  the  Mellin's  Food  may  be 
increjised  to  two  teaspoonftils,  and  given  three  times 
a  day. 

Throughout  the  eighth  and  ninth  months  five 
meals  a  day  will  suffice. 

let  meal,      7  a.m. — Milk        ,.      6|  oz. 

Cream     ...         ...         ...         h  ,, 

Sugar  of  Milk   ...         ...     60  grains. 

Water    ...         1  oz. 

2nd    ,,     10.30  a.m. — Add  to  the  foregoing  1  tablespoon ful  of 
Slellin's  Food. 

3rd  nual  at  2  p.m.,  and  4th  meal  at  6  p.m.,  same  as  2nd. 
6th  meal  at  10  p.m.,  same  as  Ist.  Equivalent  to  40  oz.  of  food 
per  diem. 

Barley  jelly  may  be  substituted  for  Mellin's 
Food.*  It  is  made  by  putting  two  tablespoonfuls  of 
washed  pearl  barley  into  a  pint  and  a  half  of  water, 
and  slowly  boiling  down  to  a  pint ;  strain,  and  let 
the  liquid  settle  into  a  jelly.  Two  teaspoonfuls  of 
this,  dissolved  in  8  oz.  of  warmed  and  sweetened  milk, 
are  enough  for  a  single  feeding,  and  such  a  meal  may 
be  allowed  twice  a  day. 

Diet  for  the  Tenth  and  Eleventh  Months. 

ist  meal,       7  a.m. — Milk 8i  fluid  oz. 

Cream  ...         ...         ...       \      ,, 

Mellin's  Food  or  Barley  \        , 

Jolly       ]       5      » 

Water  (only  when  Mel-  \      . 

lin's  Food  is  used)         )  " 

2nd     „     10.30  a.m. — 8  oz.  of  warm  milk. 
3rd     ,,       2       p.m. — The  yolk  of  an  egg,  lightly  boiled,  with 

stale  broad  crumbs. 
4th     „       6       p.m.— Same  as  1st. 
5th     ,,     10       p.m. — Same  as  2nd. 

On  alternate  days  the  third  meal  may  consist 
of  6  oz.  of  beef-tea,  with  a  few  stale  bread-crumbs. 
Mutton,  chicken,  or  veal  broth  may  be  occasionally 
used  instead  of  beef-tea.      Infant's   beef  tea   is   not 

*  Eustace  Smith 


26o  Food  in  Health.  [Pani. 

made  so  strong  as  that  for  adults,     (i  lb.  of  beef 
to  a  pint.) 

To  remedy  a  tendency  to  vomit  the  milk  in  firm 
clots,  each  bottle  at  the  age  of  six  weeks  may  consist 
of  eitlier 

Milk          ...  ...        .„        ,  l|oz. 

Cream        ... \  „ 

Sugar  of  Milk  .., 30  grains. 

Lime  Water 1|  oz. 

or 

Milk          IJoz. 

Cream        \  ,, 

Sugar  of  Milk       30  grains. 

Barley  Water       ...         1^  oz. 

Boiling  sometimes  makes  tlie  milk  more  digestible, 
and  tends  to  arrest  diarrhoea  if  it  exists. 

If  it  should  be  necessary  to  have  recourse  to  ass's 
milk,  it  should  be  used  fresh  from  the  udder.  One 
ass  is  capable  of  nourishing  three  children  for  the 
first  three  months  of  life,  two  children  for  the  fourth 
and  fifth  months,  and  one  child  after  this  period  to  the 
ninth  month. 

If  all  these  foods  disagree,  pre-digested  milk  must 
be  used.  Cheadle  considers  it  is  best  for  a  young 
infant  to  begin  with  peptonised  milk  and  water  as  a 
substitute  for  human  milk.  In  this  most  of  the  casein 
is  converted  into  soluble  peptone.  But  although  of 
great  value  as  a  temporary  food,  he  is  much  opposed  to 
its  adoj)tion  as  a  permanent  diet  for  a  healthy  infant, 
chiefly  because  it  "  weakens  the  digestive  powers  of 
the  stomach  ;"  and  he  states  he  has  "more  than  once 
seen  scurvy  arise  upon  peptonised  milk."  Complete 
peptonisation  has  the  disadvantage  of  giving  a  bitter 
taste  to  the  milk,  and  children  will  refuse  to  take  it ; 
very  young  infants  are  said  not  to  notice  it.  Par- 
tial peptonisation  is  better.  The  process  should  be 
stopped  the  instant  tlie  slightest  bitter  taste  appeal's. 

"  Peptogenic  Milk  Powder,"  made  by  Fairchild, 
can  be  conveniently  used  for  this  purpose.     It  contains 


Chap.  XL]  Substitutes  for  Milk.  261 

pancreatin,  bicarbonate  of  soda,  and  milk-sugar.     It 
can  be  used  as  follows  : — 

Take  of  Milk  2    oz. 

Water        2     „ 

Cream       \  „ 

A  measure  of  peptogenic  milk  powder. 

Heat  this  over  a  brisk  flame  to  about  1 40°  to  1 50° 
— i.e.  [)leasautly  waim  when  sipped.  Keep  at  this 
temperature  for  six  minutes.  When  properly  pre- 
l)ared  this  contains  the  albuminoids  in  a  minutely 
coagulated  and  digestible  form,  has  an  alkaline  re- 
action, contains  the  proper  proportion  of  salts,  milk- 
sugar,  and  fat,  and  has  the  appearance  of  human 
milk. 

By  shortening  the  time  of  heating,  the  degree  of 
pre-digestion  can  be  diminished. 

"Wlien  peptonised  milk  is  given,  the  peptonising 
process  should  be  gradually  reduced.  .  .  This  change 
should  not  be  abrupt ;  a  child's  stomach  resents  sudden 
changes."     (Cheadle.) 

When  milk  in  any  form,  and  however  prepared, 
still  disagrees,  it  is  best  to  omit  it  entirely,  and 
try  some  other  food  for  a  time,  such  as 

Mellin's  rood 60  grains. 

Hot  Water       3  oz. 

for  each  feeding — given  every  2  hours  at  the  age  of 
six  weeks  ;  or 

Veal  or  Chicken  Broth  (|lb.of  meat  to  pint)  I3  oz. 
Barley  Water  or  Jelly      ..     1^  „ 

or . 

Whey  1^  oz. 

Barley  Water         li  „ 

Sugar  of  Milk        \  „ 

A  teas[)Oonful  of  raw  beef-juice  every  two  hours 
will  often  be  retained  when  all  other  food  is  rejected. 
As  soon  as  milk  food  can  be  resumed,  it  of  course 
should  be  resumed. 


262  Food  in  Health.  [Parti. 

Ashby  and  Wright  recommend  a  trial  of  Biedert's 
cream  mixture  for  the  first  few  weeks  when  the  child 
cannot  digest  cow's  milk.  It  is  made  by  mixing  4  oz. 
of  ci'eam  with  12  oz.  of  warm  water,  and  adding 
~  oz.  of  milk-sugar.  It  contains  1  per  cent,  of  casein, 
2 "5  i)er  cent,  of  fat,  and  3  8  per  cent,  of  sugar.  As 
the  cliild  grows  older,  milk  is  added  till  it  reaches 
equal  parts.  Most  infants  digest  cream  exceedingly 
well.  Meigs'  modification  of  this  is  as  follows : — 
Make  a  solution  of  milk-sugar  (2 J  oz.)  in  water 
(1  pint)  ;  put  it  in  a  cool  place.  For  each  feeding 
mix  1  oz.  of  cream,  \  oz.  of  cow's  milk,  1  oz.  of  lime- 
water,  and  \\  oz.  of  the  solution  of  milk-sugar.  The 
same  authors  strongly  commend  Savory  and  Moore's 
peptonised  milk  as  very  palatable  and  easily  pre- 
pared by  mixing  with  warm  water.  Much  of  the 
casein  in  it  has  been  converted  into  peptone.  It 
keeps  well  for  a  few  days,  being  ])reserved  by  the 
addition  of  cane-sugar,  and  is  concentrated  to  i  or  A 
of  its  bulk  of  milk.  We  can  also  testify  to  the  value 
of  this  preparation.  Whey  is  a  very  useful  food, 
when  milk  disagrees,  and  is  not  so  much  used  as  it 
merits  to  be ;  shaken  up  with  a  little  white  of  egg 
and  cream,  it  fox'ms  a  highly  nutritious  mixture. 
Oatmeal  water  made  by  boiling  two  tablespoonfuls 
of  oatmeal  with  a  quart  of  water  for  four  hours  or 
longer,  and  straining  through  muslin,  is  useful  alone, 
or  mixed  with  peptonised  milk  or  cream. 

If  the  food  calculated  for  the  various  periods  of 
infant  life  should  appear  to  be  in  excess  of  the  child's 
wants,  the  quantity  can  be  reduced  to  that  proper  for 
the  period  next  below  it. 

Food  containing  barley  jelly,  or  made  with  oat- 
meal, arrowroot,  baked  fiour,  etc.,  either  with  or 
without  milk,  can  be  readily  predigested,  or  partially 
80,  as  follows  : — 


Barley  Jelly         J  oz. 

Sugar  of  Milk      , 60  grains. 

Warm  Milk  ...         .^         8  oz. 


Chap.  XI.]  Substitutes  for  Milk.  263 

Add  3  grains  of  Fairchild's  Extractum  Paucreatis 
and  5  grains  of  bicarbonate  of  sodium,  and  keep  warm 
for  half  an  hour  before  feeding. 

Peptonised  beef-tea  may  be  given  wlien  the  child 
is  of  an  age  to  take  meat-broth.  Cheadle  recom- 
mends a  mixture  of  bread  jell}',  raw-meat  juice, 
cream  and  sugar  as  a  very  nutritious  and  valuable 
infant's  food.  The  bread  jelly  and  the  meat  juice 
are  prepared  in  the  following  manner.  To  make 
the  bread  jelly : — 


Take  4  oz.  of  crumb  of  bread  made  of  seconds  flour  two  or 
three  days  old,  soak  in  cold  water  for  six  or  eight  liours ;  then 
squeeze  all  the  water  out  of  it  (lactic  acid  and  other  peccant 
matters  are  thus  removed).  Place  the  pulp  in  a  pint  of  fresh 
water,  and  boil  gently  for  an  hour  and  a  half,  so  as  to  break  up 
the  granules  of  starch  and  promote  its  conversion  into  dextrin 
and  glucose. 

Hub  this  .semi-fluid  gruel  through  a  fine  hair-sieve  ;  when 
cold,  it  forms  a  smooth  jelly. 

For  childien  who  can  digest  no  milk,  this  jelly  may  be 
simply  mixed  with  enough  warm  water  (one  ta>tlespoonful  to 
8  oz.  of  water)  so  as  to  have  the  consistence  of  thin  ci'eam,  and 
a  little  refined  sugar  added. 

To  make  it,  however,  a  suitable  food  for  more  than  merely 
temporary  purposes,  it  would  need  the  addition  of  sonae  albu- 
minate and  some  fat.  Its  percentage  composition,  mixed  in 
the  proportions  stated,  is — proteids,  074;  fat,  013;  carbo- 
hydrates, 4' 15. 

If  the  addition  of  milk  can  be  tolerated,  then  a  mixture  of 

3  oz.  of  bread  jelly  to  4  oz.  of  milk  (or  peptonised  milk)  and 

4  oz.  of  water  will  make  a  fairly  good  food  ;  or  the  necessary 
amount  of  proteids  and  fat  may  be  obtained  by  the  addition  of 
raw-meat  juice  and  cream. 

The  raw^meat  juice  is  directed  to  be  thus  pre- 
pared : — 

Slince  fine  the  best  rump  steak,  then  add  cold  water  in  the 
propoition  of  one  part  of  water  to  4  of  meat.  Stir  this  well 
together  and  allow  it  to  soak  for  half  an  hour.  Express  the 
juice  by  forcibly  twisting  this  through  muslin.  This  juice 
contains  51  per  cent,  of  proteids,  21  of  extraction,  and  07 
of  gaits. 


^' 


264  Food  in  Health.  [Parti. 

The  following  is  the  mixture  : — 

Four  parts  of  the  above  bread  jelly  mixture  (with  water 
only),  three  parts  of  raw-meat  juice,  half  a  part  of  cream,  and 
one-fifth  part  of  sugar.  The  bread  jelly  and  the  raw-meat 
juice  must  be  quite  fresh,  and  made  twice  a  day. 

Raw-meat  juice  Cheadle  considers  the  "best 
material  for  supplying  proteids  to  the  food  of  children 
who  cannot  digest  a  sufficient  amount  of  the  milk 
proteid-casein,"  and  from  its  richness  in  salts  he 
regards  it  as  an  excellent  anti-scorbutic. 

After  the  first  year  far  less  change  is  needed  in  the 
food  from  month  to  month. 

Diet  prom  Twelfth  to  Eighteenth  Month. 

Tivc  meals  a  day. 

Ibt  meal,     7  a.m. — A  slice  of  stale  bread,  broken  and  soaked 

in  8  oz.  new  milk. 
2nd    „        10  a.m. — 6  oz.  of  milk  with  a  soda  biscuit,  or  thin 

slice  of  buttered  bread. 
3rd     ,,  2  p.m. — 6  oz.  of  beaf-tea,  with  a  slice  of  bread. 

One  good  tablespoonful  of  milk  and  rice 

pudding. 
4th     „         6  p.m. — Same  as  1st. 
6th     „       10  p.m.  —One  tablespoonful  of  Mellin's  Food,  with  a 

breakfastcupful  of  milk. 

These  quantities  may  prove  too  much,  except  for 
very  robust  children,  and  it  must  be  noted  whether 
they  cause  any  indigestion,  and  if  so  they  must  be 
diminished. 

As  AN  Alternative  Diet. 

Ist  meal,     7  a.m. — The  yolk  of  an  egg  lightly  boiled,  with 

bread-crumbs.    A  teacupful  of  new  milk. 
2nd    ,,        10  a.m. — A  teacujjful  of  milk,  with  a  thin  slice  of 

buttered  bread. 
3rd     ,,         2  p.m. — A  mashed  boiled  potato,  moistened  with  4 

tablospoonfuls  of    beef-tea.     Two   good 

tablcspoonfuls  of  junket. 
4th     „         6  p.m. — A  breakfastcupful  of  new  milk,  with  a  slice 

of  bread  broken  up  and  soaked  in  it. 
6tli  10  p.m. — Same  as  2nd. 


Chap.  XI.]      Dietary  FOR   Young  Children.       265 

The  fifth  meal  is  not  always  necessary,  and  sleep 
should  not  be  disturbed  for  it.  A  ca})  of  warm  milk 
should,  however,  be  available  daring  the  night  if 
required. 

Diet  fkom  Eighteen  Months  to  Two  and  a  Half  Years. 

Ist  meal,  7  a.m. — A  breakfastcupful  of  now  milk,  the  yolk  of 
an  egg  lightly  boiled,  2  t'lin  slices  of 
bread  and  butter. 

2nd    „        11  a.m. — A  tcacupful  of  milk  with  a  so(?a  biscui*^. 

3rd     ,,  2  p.m. — A   breakfastcupful  of  beef-tea,  mitton  or 

chicken  broth ;  a  thin  slice  of  stale 
bread ;  a  saucer  of  rice  and  milk  pudding. 

4th  ,,  6.30  p.m. — A  breakfastcupful  of  milk  with  bread  and 
butter. 

As  AN  Alternative  Diet. 

1st  meal,  7  a.m. — Two  tablespoonfuls  of  thoroughly-cooked 
oatmeal  or  wheaten  grits,  with  sugar  and 
cream  ;  a  teacupf ul  of  new  milk. 

2nd  „  11  a.m. — A  teacupf  ul  of  milk,  with  a  slice  of  bread 
and  butter. 

3rd    „  2  p.m. — One  tablespoonful  of   underdone  mutton, 

pounded  to  a  paste ;  bread  and  butter, 
or  mashed  baked  potato,  moistened  with 
good  plain  dish  gi'avy ;  a  saucer  of 
junket. 

4th  „  6.30  p.m. — A  breakfastcupful  of  milk,  a  slice  of  soft 
milk-toast,  or  a  slice  or  two  of  bread 
and  butter. 

If  these  diets  at  any  time  disagree,  return  to 
a  plain  milk  diet,  or  milk  with  Mellin's  Food. 

The  preceding  tables  must  only  be  taken  as 
indicating  averages.  Many  children  thrive  best  on  a 
purely  milk  diet  up  to  the  age  of  two  or  two  and  a 
half  years.  When  a  child  is  thriving  and  content  on 
milk  diet,  be  in  no  haste  to  alter  it. 

It  should  not  be  forgotten,  as  is  sometimes  the 
case,  that  a  child,  however  young,  occasionally  re- 
quires, and  is  better  for,  a  drink  of  water.  Pure 
water,  not  too  cold. 

The  most  scrupulous  cleanliness  must  be  observed 
with  regai-d  to  all  the  vessels  containing  the  infant's 


266  Food  in  Health.  [Pani. 

food.  Each  meal  must  also  be  prepared  at  the  time 
it  is  wanted,  and  not  taken  from  a  stock  on  hand. 
The  temperature  of  the  food  of  young  infants  should 
be  about  95°  F. 

It  is  also  most  important,  unless  the  source  of  the 
milk  supply  is  absolutely  above  suspicion,  that  all  milk 
used  for  feeding  infants  should  be  boiled  or  sterilised. 
A  description  of  methods  of  sterilising  milk  will  be 
found  in  the  Appendix. 

Children  who  have  cut  their  milk-teeth  may  be  fed 
for  a  twelvemonth — i.e.  up  to  the  age  of  three  and  a 
half  years — as  follows  :  — 

1st  meal,  7  a.m. — One  or  two  tuniblerfuls  of  milk,  a  saucer  of 
thoroughly  cooked  oatmeal  or  wheaten 
grits,  and  a  slice  of  bread  and  butter. 

2nd  „  11  a.m. —  (If  hungry.)  A  tumblerful  of  milk,  or  a 
teacupful  of  beef-tea,  with  a  biscuit. 

3rd     „  2  p.m. — A  slice  of  underdone  roast  beef  or  mutton, 

or  a  bit  of  roast  chicken  or  turkey, 
minced  as  finely  as  possible ;  a  baked 
potato,  thoroughly  mashed  with  a  fork, 
and  moistened  with  gravy  ;  a  slice  of 
bread  and  butter;  a  saucer  of  junket,  or 
rice  and  milk  pudding. 

4th     „  7  p.m. — A  tumblerful  of  milk,  and  one  or  two  slices 

of  well-moistened  milk-toast.^ 

For  the  rest  of  childhood,  a  chief  point  is  to 
see  that  the  child  does  not  eat  hastily,  but  masticates 
his  food  leisurely. 

The  diet  should  be  plain,  but  varied,  and  the 
following  lists  of  suitable  dishes  from  which  to  select 
may  serve  as  a  convenient  guide  :— 


Breakfast. 


Daily. 

Milk. 

Porridge  and  Cream, 

Bread  and  butter. 


One  dish  only  each  day. 

Fresh  fish. 

Eggs,  lightly  cooked. 
Chicken  hash. 
Grilled  fat  bacon. 


Thoroughly  ripe  sound  fruit  may  be  allowed  with 
this  meal  in  small  or  moderate  quantity. 


Chap.  XL]       Dietary  for    Young  Children,     zti 

DiNNEB. 


Daily. 

Clear  Soup. 

Meat,  roasted  or  broiled, 

and   cut  into  small 

pieces. 
Bread  and  butter. 


Two  dishes  each  day. 

Potatoes,  baked  and 
Spinach.  [mashed. 

Stewed  celery. 
Cauliflowers. 
Hominy. 
]Mac<ii"oni,  plain. 
Peas. 
French  beans. 

Junket,  rice  and  milk,  or  other  light  pudding. 

Supper, 

Daily. 
Milk. 

Milk-toast;  or  bread  and  butter. 
Stewed  fruit. 

As  to  quantity,  if  a  child  eats  slowly  and  masti- 
cates tlioroughly,  he  may  generally  be  trusted  to  satisfy 
his  appetite  at  each  meal.  Fried  food  and  highly- 
seasoned  dishes  should  be  avoided.  Salt,  but  no  other 
condiment,  should  be  allowed,  and  pure  water  should 
be  the  only  drink.  Some  feeble  and  thin  children 
may,  howevei",  be  allowed,  from  time  to  time,  a  little 
sound  beer  or  porter. 

Recently,  in  America  especially.  Kefir,  the  product 
of  fermentation  of  cow's  or  goat's  milk,  has  been 
higlily  extolled  as  a  substitute  for  mother's  milk.  It 
is  manufactured  like  koumiss,  and  has  been  used  for 
ages  in  the  Caucasus. 

Keiir  is  a  partially-digested  milk,  and  is  believed 
by  some  to  fulfil  an  important  indication  in  infant 
feeding — namely,  the  breaking  up  of  the  curd  of  cow's 
milk  without  introducing  indigestible  matter  into  the 
infant's  stomach. 

As  the  casein  of  cow's  milk  is  exactly  the  same  as 
that  of  human  milk,  the  difl'erence  in  the  curding 
must  be  due  to  something  which  is  found  in  the  one 
and  not  in  the  other.  Schmidt  has  shown  that  this 
is  due  to  the  presence  in  human  milk  of  hemi-albumen 
in  proportionately  larger  quantities  than  in  cow's  mUk. 


268  Food  in  Health.  tPani. 

In  kefir  we  liave  the  soluble  forms  of  albumen 
due  to  the  action  of  the  ferment,  and  consequently  the 
light,  flocculent  coagulation. 

Food  at  school.— Assuming  that  the  period 
of  school-life  extends,  on  an  average,  from  ten  to 
eighteen  years  of  age,  it  is  scarcely  necessary  to  say 
that  this  is  one  of  the  most  critical  and  most  impoi'tant 
epochs  in  the  life  of  the  individual  as  regards  sufficient 
and  adequate  nutrition.  It  is  a  time  of  active  growth 
and  development  both  physical  and  intellectual,  and 
it  is  a  time  when  any  serious  check  to  the  perfect  and 
complete  evolution  of  the  oi'gans  and  functions  of  the 
body  may  lead  to  ineradicable  mischief,  and  severely 
handicap  the  individual  in  the  subsequent  "  struggle 
for  existence." 

Those  who  are  entrusted  with  the  care  of  the 
young  of  both  sexes  during  this  period  are,  perhaps, 
sometimes  apt  to  regard  with  too  little  attention  and 
interest  the  physical  development  of  those  under  their 
charge,  and  this  from  a  too  great  eagei-ness  to  promote 
their  intellectual  culture.  It  should  be  remembered 
that  the  education  of  the  mind  is,  and  should  be,  a 
lifelong  process — there  is  no  need  of  hurry,  but  that 
the  development  of  the  body  is  strictly  limited  to 
a  certain  period  of  existence,  and  becomes  finally  and 
irrevocably  arrested  at  a  given  date. 

It  should,  then,  be  ever  present  in  the  minds 
of  those  who  undertake  the  education  of  youth  that 
they  are  in  a  special  and  peculiar  way  responsible  for 
their  physical  growth  and  development,  and  that  these 
cannot  proceed  satisfactorily  without  a  careful  and 
intelligent  arrangement  and  supervision  of  their  food. 
And  not  only  is  this  period  of  life  one  of  continuous 
growth  and  development ;  it  is  also  one  of  remarkable 
physical  activity.  So  that  there  is  a  constant  and 
twofold  demand  for  apjn'opriate  food — the  demand  of 
the  growing  organs,  and  the  demand  connected  with 
muscular  activity  and  mental  training.  At  no  period 
of  life  is  it  so  necessary  to  be  provided  with  a  complete 
and  liberal  dietary. 


Chap.  XI.]  Food  at  School.  269 

Another  point  which  is  very  constantly  overlooked 
is  the  rapidity  and  activity  of  the  digestive  and 
assimilative  functions  in  many  growing  young  folk; 
and  provision  should  always  be  made  for  some  plain 
and  wholesome  food,  such  as  bread  and  butter,  or 
bread  and  cheese,  to  be  accessible  to  the  hungry 
boy  or  girl  at  other  than  the  ordinary  meal-times. 
The  rate  of  growth  in  any  individual  cannot  be  con- 
trolled or  regulated  by  general  rules,  and  when  this 
is  taking  place  with  exceptional  rapidity  exceptional 
quantities  of  food  are  needed. 

The  diet  at  school  must  not  only  be  abundant  in 
quantity ;  it  must  also  be  suitable  in  quality.  It 
must  contain  a  proper  proportion  of  albuminates,  to 
minister  to  the  growth  of  the  muscular  and  other 
tissues ;  it  must  contain  fats  and  starches,  for  the 
development  of  heat  and  muscular  energy,  and  the 
former  is  an  important  agent  in  tissue-growth;  and 
it  must  contain  the  necessary  proportions  of  mineral 
substances  to  funiish  the  materials  necessary  for  the 
growth  and  consolidation  of  the  hard  tissues,  as  the 
bones  and  teeth,  especially  phosphates  of  lime. 

In  the  remarks  which  follow  we  have  to  acknow- 
ledge our  indebtedness  to  the  valuable  experience  of 
Dr.  Clement  Dukes,  the  Medical  Officer  of  Rugby 
School,  as  set  forth  in  his  excellent  work  on  "  Health 
at  School,"  with  whose  views  we  are,  with  one  or 
two  exceptions,  in  entire  accord.  In  considering 
the  details  of  a  school  dietary  he  calls  attention  to 
the  need  of  more  variety,  both  in  the  kinds  of  food 
provided  and  the  manner  in  which  they  are  cooked 
and  served.  The  likes  and  dislikes  of  young  children 
should,  he  considers,  be  more  consulted,  as  affording 
trustworthy  indications  of  what  suits  their  constitu- 
tions. Some  cannot  digest  fats  or  starches — even  the 
sight  of  fat  will  prevent  their  eating.  This  is,  no 
doubt,  greatly  to  be  regretted,  as  both  fats  and 
starches  are  very  important  alimentary  substances ; 
still,  they  may  nearly  always  be  given  in  certain  com- 
binations, and  many  children  who  would  not  touch 


270  Food  in  Health.  [Parti. 

the  fat  of  roast  or  boiled  mutton  will  eagerly  devour 
suet  pudding  witli  sugar  or  jam.  The  objections  to 
certain  important  food  substances  which  children  some- 
times manifest  should,  if  possible,  be  corrected,  or  the 
attempt  be  made  to  correct  them,  in  early  childhood 
(it  is  often  too  late  to  do  so  at  school) ;  for  the 
acquirement  of  certain  strong  distastes  to  particular 
articles  of  food  often  proves  exceedingly  embaiTassing 
in  after-life.  What  can  be  more  troublesome  to  the 
physician  in  dealing  with  the  food  of  invalids  to  find, 
as  he  sometimes  does,  a  rooted  distaste  and  objection 
to  milk  ?  It  is  difficult  to  believe  that  suclr  a  distaste 
is  not  often  a  fault  of  education.  We  are  disposed  to 
urge,  as  a  qualification  of  Dr.  C  Dukes's  recommenda- 
tion, that  the  likes  and  dislikes  of  school-childi*eu 
should  be  considered,  that  they  should  only  be  so 
after  repeated  judicious  attempts  have  been  made  to 
overcome  them. 

Another  suggestion  that  Dr.  Dukes  makes  is  that 
the  craving  of  school-children  for  sweets  should  be 
gratified,  that  their  clandestine  visits  to  the  con- 
fectioner's are  the  result  of  a  natural  craving  which 
should  be  gratified  in  a  regular  and  legitimate  fashion. 
The  cooking,  also,  he  urges,  should  be  more  carefully 
looked  after,  as  roast  joints  are  often  so  imperfectly 
cooked  and  underdone  as  to  lie  unwholesome,  as  well 
as  unpleasant  to  look  at ;  while  the  distaste  often 
manifested  for  gi-een  vegetables  too  fiequently  origin- 
ates in  the  careless  manner  in  which  they  are  cleaned 
'and  the  peculiarly  unattractive  fashion  in  which  they 
are  serjfid.  In  large  establishments  it  would  involve 
vCT^httle  extra  trouble  to  serve  the  green  vegetaljles 
in  the  form  of  purees,  nicely  flavoured  ;  and  as  a 
laxative  food  this  would  prove  most  useful  in  neces- 
sitating daily  attention  to  the  bowels,  which  boys  and 
girls  at  school  often  neglect.  The  personal  super- 
vision of  the  master  or  his  wife  is  invoked  in  these 
matters  as  well  as  in  more  attractive  carviny. 

Another  highly  important  matter  in  the  arrange- 
ment of  meals  at  school  is  that  the  pupils  should  be 


Chap.  XI.]  Food  at  School.  271 

allowed  ample  and  sufficient  time  to  eat  them,  and  the 
master  should  see  that  the  food  is  properly  masticated, 
or,  at  any  rate,  that  sufficient  time  is  allowed  for  this 
process,  as  imperfect  mastication  is  a  common  cause  of 
indigestion,  and  may  become  an  injurious  habit,  which, 
like  other  bad  habits,  should  be  corrected  at  school. 

It  seems  that  in  certain  schools,  or  with  certain 
masters,  boys  are  sometimes  detained  in  school  as 
a  punishment  during  a  portion  of  the  dinner  or 
breakfast  time,  so  that  the  time  available  for  feed- 
ing is  seriously  encroached  upon.  Such  a  system 
shows  a  lamentable  absence,  in  the  authorities,  of 
the  most  elementary  understanding  of  the  conditions 
of  health. 

The  number  of  meals,  and  the  hours  fixed  for 
taking  them,  ai-e  also  serious  matters,  aad-oipecially 
,witl»-gPOwiBg  ^irls. 

It  is  undesii*able,  especially  with  the  younger  and 
less  robust  pupils,  that  they  should  be  given  any  task 
before  breakfast.  The  practice  of  preparing  a  lesson 
at  7  a.m.,  on  an  empty  stomach,  and  after  a  long  fast, 
especially  in  winter,  is  indefensible.  Tlie  pupils 
should  be  allowed  hot  milk,  or  hot  coffee  and  milk,  or 
cocoa,  with  a  piece  of  bread,  before  going  into  school 
at  all.  This  is  most  essential  for  the  delicate  or 
average  boy  or  girl. 

At  6.45  to  7. 15  a.m.  there  should  be,  then,  a  provision  of  hot 
coffee,  or  cocoa,  with  plenty  of  milk — a  beverage  both 
nutritious  and  stimulating. 

At  8.30  a.m. — Breakfast,  after  the  first  lesson ;  this  should  be  a 
good  meal,  with  some  animal  food— ham,  bacon,  cold  beef, 
fish,  or  eggs.  Some  porridge.  Bread  and  butter,  or  jam 
or  marmalade.     Hot  milk  and  water,  or  coffee. 

(Everything  should  be  provided  for  the  boys,  and  they 
should  not  be  required  to  buy  anything  for  themselves.) 

At  1.30  p.m. — Dinner,  which  should  be  a  good  meal  of  meat, 
pudding,  potatoes  or  green  vegetables,  or  haricot  beans, 
pease-pudding,  etc. 

(School  should  cease  at  least  15  minutes  before  the  meal,  to 
give  the  boy  time  to  wash  and  prepare  himself  for  dinner.) 


272  Food  in  Health.  [Pani. 

6  to  6  p.m. — Tea,  with  bread  and  butter,  an  &^^^  marmalade, 
jam,  or  potted  meat. 

Water-cress,  lettuce,  celery,  or  other  fresh  salads  might  be 
served  at  this  meal  or  at  supper. 

As  to  supper,  Dr.  Dukes  thinks  boys  should  either 
not  have  any  supper,  so  that  they  may  go  to  bed 
without  food  in  their  stomachs,  or  that  merely  bread 
and  butter,  or  bread  and  milk,  or  a  glass  of  milk  or 
water  should  be  provided.  He  strongly  objects  to 
cheese,  meat,  beer,  or  pastry  at  supper ;  he  considers 
a  meat  supper  with  beer  as  most  objectionable  in 
growing  boys,  as  tending  to  excite  their  passions  and 
calculated  to  lead  to  immorality. 

We  cannot  altogether  accept  these  unqualified 
objections  to  supper.  Our  own  view  is  that,  instead 
of  a  meal  at  5  or  6  p.m.,  only  a  few  hours  after 
a  heavy  dinner,  it  would  be  better  to  serve  simply 
coffee,  cocoa  or  tea,  or  hot  milk  and  water  at  tliat  hour, 
and  provide  a  fairly  nutritious,  but  unstiraulating, 
supper  at  8  p.m.  Porridge  niade  with  milk  would  be 
excellent ;  or  tapioca,  or  rice  pudding,  with  mar- 
malade, or  bread  and  butter  with  some  salad  or  fruit, 
or,  in  winter,  some  good  soup  with  bread  or  other  fari- 
naceous substance,  or  any  other  light,  but  nutritious, 
food.  The  need  for  this  seems  to  us  obvious.  We 
are  dealing  with  a  period  of  rapid  growth  when 
digestion  and  assimilation  are  active  ;  and  it  is,  surely, 
undesirable  that  a  fast  extending  from  a  light  meal 
at  5  or  6  p.m.,  to  7  a.m.,  and  sometimes  8  a.m.,  the 
following  day — a  fast  of  thirteen  or  fourteen  hours 
— should  be  inflicted  on  a  rapidly-growing  boy  or 
girl. 

This  prolonged  fast  has  appeared  to  us  to  be 
attended  with,  and  often  to  be  the  cause  of,  serious 
loss  of  health,  especially  in  girls'  schools.  For  it  must 
be  remembered  that  girls  between  twelve  and  sixteen 
years  of  age  often  develop  with  amazing  rapidity, 
and  require  ample  and  frequent  supplies  of  food.  We 
are  fully  convinced  that  the  anfemia  and  constipation 


Chap,  xi.i  Food  at  School,  273 

so  commonly  observed  among  young  girls  at  the 
approach  of  puberty  are  frequently  due  to  insufficient 
supplies  of  food,  or  to  food  of  unsuitable  quality. 
The  constipation  is  probably  due  to  a  deficiency  in 
fresh  vegetables,  and  the  want  of  a  sufficiently  bulky 
and  stimulating  diet ;  while  the  anaemia  is,  in  many 
instances,  the  direct  result  of  an  imperfect  supply  of 
animal  flesh— that  is,  of  food  which  contains  the 
maximum  of  iron  and  the  material  necessary  for  red 
corpuscle-making. 

As  to  different  articles  of  diet,  we  can  coincide 
with  most  of  Dr.  Dukes's  recommendations. 

The  bread  should  be  wholemeal  bread.  This  is  no 
doubt  the  best  bread  for  growing  children  and  young 
people.  There  is  little  risk  of  their  not  being  able  to 
digest  it,  and  it  is  certainly  richer  in  the  mineral 
substances  they  especially  require  than  fine  white 
bread.  But  what  is  of  far  more  importance  is  that  the 
bread  should  be  well  made — that  it  should  bo  good 
and  palatable,  not  sour,  sticky,  or  musty.  The  al- 
lowance of  bread  should  not  be  limited,  and  butter 
should  be  given  with  it,  as  wheaten  bread  is  deficient 
in  fats. 

Farinaceous  and  saccharine  foods  should  be  freely 
supplied  as  heat-  and  force-developing  foods,  and  as 
more  digestible  than  fats. 

A|ilk    should    be    abundantly    provided    for     all 

adolescents  as  an  essential  part  of  their  regular  diet. 

It  contains  all  the  necessary  elements  of  food  in  a 

readily  assimilable  form,  and  is  particularly  fitted  for 

nourishment  during  rapid  growth.      Wlien  there  is 

/Hffy  possibility  of  its  serving  as  the  medium  of  the 

/  conveyance   of  disease  it   should    be   boiled    before 

/    consumption. 

Meat  should  l)e  provided  twice  a  day — at  brenkfast 
and  dinner — during  the  time  of  active  growth.  This 
may  be  in  theformof  ordinary  butcher's  meat,  or  fish 
bacon,  sausages,  eggs,  etc. 

Dr.  Dukes  estimates  that  1  lb.  of  uncooked  meat 
should   be  the    average    ration,  including    fat :    tliia 


i 


274  IvoD  IN  Health.  [Parti. 

would  yield  about  9i  ounces  of  cooked  meat,  allowing 
a  loss  of  40  per  cent,  for  bone  and  cooking. 

All  boys  do  not  require  so  much  as  this,  only  the 
biggest  and  strongest. 

Monotony  should  be  avoided,  and  more  effort 
should  be  made  to  give  variety  to  the  food  provided 
at  different  meals. 

Fish  should  be  more  largely  utilised,  and  a  fish  day 
once  or  twice  a  week,  in  places  where  a  good  supply 
of  fresh  fish  is  available,  should  be  instituted. 

Attempts  should  be  made,  as  has  already  been 
said,  to  o\ercome  the  distaste  that  exists  for  green 
vegetables.  They  should  be  cooked  and  served  in 
a  more  attractive  form ;  or  soup  with  plenty  of 
vegetables  should  be  given  once  or  twice  a  week  in 
winter  ;  or  beetroot,  pickles,  and  salad  should  be  more 
freely  provided.  This  is  of  much  importance,  as 
eczema  is  prone  to  ap])ear  amongst  boys  at  school 
who  are  kept  on  a  too  exclusively  animal  diet. 

Puddings  or  pastry  should  be  provided  frequently 
at  dinner,  and  visits  to  the  pastrycook's  before  dinner 
should  be  strictly  prohibited.  "  Hampers  "  are  objec- 
tionable and  a  frequent  cause  of  illness. 

Beer  is  only  needed  by  the  more  delicate  boys,  but 
we  have  seen  thin,  delicate  boys  with  small  appetites 
greatly  benefited  by  a  glass  of  light,  sound  beer  with 
dinner. 

The  greater  relative  defects  in  the  diet  of  girls' 
schools  were  animadverted  upon  some  years  ago  by  the 
late  Dr.  Combe.  He  pointed  out  then  that  the  system 
of  diet  "  in  female  boarding-schools  is  often  insufficient 
for  due  sustenance  and  growth,  and,  consequently, 
the  natural  expression  of  impaired  health,  if  not  actual 
disease,  is  a  marked  feature  in  the  aspect  of  most  of 
the  pupils.  So  defective  indeed  is  the  common  school 
management  in  this  and  other  respects  that  we  have 
the  best  authority  for  considering  it  as  a  rare  excep- 
tion for  a  girl  to  return  home  in  full  health  after 
spending  two  or  three  years  at  an  English  boarding- 
school.     Germain  Sde  also  insists  upon  the  urgent 


Chap. XL]  Food  at  School.  275 

necessity  of  paying  more  attention  to  the  feeding 
of  young  girls  at  school.  We  should  understand, 
he  says,  "  the  absolute  necessity  of  animal  food,  of 
abundance  of  meat  plainly  cooked,  which  contains 
all  the  principles  of  the  blood,  fibrin,  hix?moglobin, 
and  iron  itself,  in  sufficient  amOunt  to  enable  us  to 
dispense  with  ferruginous  drugs.  Such  an  albuminous 
diet,  together  with  nitrogenous  farinaceous  foods  and 
fish,  and  an  abundant  supply  of  oxygen  and  an  open- 
air  life,  supplies  all  that  is  required." 

In  a  model  French  lycee  at  Paris  lie  foimd  the 
following  arrangements  as  to  food  : — 

For  the  first  breakfast :  Chocolate,  milk,  soup,  or  cafe-au-lait. 

As  to  meat,  this  is  calculated  as  cooked  meat  from  which  fat 
and  bones  have  been  removed. 

The  oldest  pupils   get  100  grammes  at  each  meal,    i.e.    200 
grammes  (about  7  oz.)  daily. 

The  older  pupils  of  the  second  and  third  classes,  85  grammes 
each  meal,  i.e.  170  grammes  (about  6  oz.)  daily. 

The  series  of  average  pupils,  70  grammes,  i.e.  140   grammes 
(about  5  oz.)  daily. 

And  the  smaller  boys,  60  grammes,  i.e.  100  grammes  (3|  oz.) 
daily. 

Three  times  a  week,  on  Sundays,  Tuesdays,  and 
Thursdays,  at  the  midday  meal  they  get  two  courses 
of  meat  =  134  grammes  (nearly  5  oz.)  for  the  oldest, 
112  (4  oz.)  for  the  next,  94  (about  3^  oz.)  for  the 
next,  and.  the  small  boys  84  (3  oz.). 

It  will  be  seen  that  during  three  days  in  the  week 
the  eldest  pupils  get  at  tlie  midday  and  evening 
'meals  together  234  grammes  of  cooked  meat  (8  oz.) 
This  is  about  the  quantity  necessary ;  but  the 
other  (juantities  are  much  too  small,  and  the  great 
reductions  made  for  the  younger  boys  are  quite 
unjustifiable. 

On  ordinary  days  the  eldest  boys  get  only  7  oz. 
(200  grammes)  of  meat,  which  is  not  enough,  and  the 
youngest  only  3|  oz.  (100  grammes),  which  is  a  serious 
r2 


276  Food  in  Health.  [Parti. 

deficiency.  This  allowance  of  meat  is  what  is  given 
in  one  of  the  model  lycees.  Professor  G.  See  states 
that  in  many  others  the  feeding  is  far  more 
defective. 

Food  ill  adult  life. — The  considerations  which 
should  guide  us  in  determining  the  food  appropriate 
to  adult  life  have  already  been  incidentally  dwelt 
upon.  In  the  first  place  we  have  to  consider  the 
circumstance  that  growth  and  development  are  for  the 
most  part  over  ;  but  it  must  also  be  remembered  that 
although,  in  young  adults,  the  framework  or  skeleton 
of  the  body  has  ceased  to  grow,  it  is  by  no  means 
certain  that  other  organs  of  the  body  have,  in  all  cases, 
reached  their  full  development ;  and  it  is  a  very 
well-known  fact  that  the  body,  especially  in  the  male, 
commonly  continues  to  increase  in  weight  for  some 
years  after  adult  life  has  been  attained.  It  is 
prudent,  in  many  instances,  to  i-egard  the  young  man 
as  not  having  quite  completed  his  physical  develop- 
ment until  he  has  reached  his  twenty-third  or  twenty- 
fifth  year.  Complete  organic  development  is  much 
earlier  arrived  at  in  the  human  female. 

When,  however,  growth  and  development  are 
completely  over,  it  is  clear  there  cannot  be  precisely 
the  same  food  requirements  as  exist  when  growth  and 
development  are  in  active  progress.  But  throughout 
healthy  and  active  adult  life,  although  food  is  no 
longer  needed  for  the  purposes  of  growth,  it  is  needed 
in  due  and  sufficient  amount  to  meet  all  the  require- 
ments attending  the  daily  work  of  the  organism, 
to  supply  the  force  developed  in  the  various  forms  of 
energy  which  the  human  body  normally  displays,  and 
to  keep  in  sound  repair  all  the  various  organs 
employed. 

The  food  appropriate  to  adult  life  must  thus  de 
pend  very  greatly  on  the  conditions  and  circumstances 
which  affect  each  individual — on  sex,  on  physical 
development,  on  occupation,  on  climate,  on  habits, 
and  other  personal  peculiarities. 

The  general  principles  which  should  govern  ns.  in 


Chap.  XI.]     Over-feeding  in  Adult  Life.  277 

dealing  with  individual  cases,  may  be  gathered  from 
what  has  been  said  in  preceding  chapters.  A  few 
points  only  in  the  application  of  these  will  here  be 
dwelt  upon. 

Much  has  recently  been  written  on  the  tendency 
to  over-feeding  in  adults,  and  there  can  be  no  doubt 
that  too  much  food  is  habitually  consumed  by  great 
numbers  of  the  rich  and  leisured  classes ;  but  we 
must  be  extremely  careful  not  to  apply  this  conclu- 
sion too  generally,  or  to  persons  whose  diets  are  fixed 
for  them,  and  who  have  no  choice  in  the  matter. 
Too  little  food  is  probably  more  injurious  than  too 
much,  and  it  is  quite  possible,  as  has  been  authorita- 
tively asserted,  that  "  the  efl'ects  of  casual  repletion 
are  less  prejudicial  and  more  easily  corrected  than 
those  of  inanition."  It  is  not,  however,  casual,  but 
habitual,  i-epletion  that  has  been  protested  against.  A 
young  man  in  sound  health,  and  taking  very  active 
exercise,,  may  exceed  occasionally,  without  any  great 
harm,  but^  frequent  or  habitual  excess  will  leave  a 
"surpl.us  fund  of  nutrient  material  unused,  to  be 
stored  up  in  some  form.  When  a  certain  amount  has 
been  thus  disposed  of,  the  capacity  for  stoi'age  varying 
greatly  in  different  persons,  an  undesii'able  balance 
remains  against  the  feeder."  What  is  termed  a 
"  bilious  attack  "  may  rectify  this,  and  each  recurring 
attack  may  "  clear  the  system,  and  so  on  during  several 
years  of  life.  If  the  individual  takes  abundant 
exercise  and  expends  much  energy  in  the  business  of 
life,  a  large  quantity  of  food  can  be  properly  disposed 
of.  On  the  other  hand,  if  he  is  inactive,  takes  little 
exercise,  spends  most  of  his  time  in  close  air  and  in  a 
warm  temperature,  the  balance  of  unexpended  nutri- 
ment soon  tells  more  or  less  heavily  against  him,  and 
must  be  thrown  off  in  some  form  or  other,  more  or  less 
disagreeable."* 

"  After  the  first  half  or  so  of  life  has  jiassed  away, 
instead  of   such    periodical  attacks  of  sickness,    the 
unemployed  material  may  be  relegated  in  tlie  form  of 
•  Sir  H.  Thompson's  "Diet  in  Relation  to  Age  and  Activity." 


278  Food  in  Health.  [Pani. 

fat  to  be  stored  on  the  external  surface  of  the  body, 
or  be  packed  among  the  internal  organs,  and  thus  he 
or  she  may  become  corpulent  and  heavy,  if  a  facility 
for  converting  appropriate  material  into  fat  is  con- 
sistent with  the  constitution  of  the  individual ;  for 
some  constitutions  appear  to  be  without  the  power  of 
storing  fat,  however  rich  the  diet  or  inactive  their 
habits  may  be.  When,  therefore,  this  process  cannot 
take  place,  and  in  many  instances,  also,  when  it  is  in 
action,  the  over-supply  of  nutritious  elements  ingested 
must  go  somewhere,  more  or  less  directly,  to  produce 
disease  in  some  other  form,  probably  at  first  interfer- 
ing with  the  action  of  the  liver,  and  next  appearing 
as  gout  or  rheumatism,  or  as  the  causes  of  fluxes 
and  obstructions  of  various  kinds.  Thus  recurring 
attacks  of  gout  perform  the  same  duty,  or  nearly 
so,  at  this  period  of  life  that  the  bilious  attacks 
accomplish  in  youth,  only  the  former  process  is  far 
more  damaging  to  the  constitution,  and  materially 
injures  it." 

Thus  it  is  that  excess  of  food  in  adult  age  ministers 
to  the  development  of  disease  in  more  advanced  life. 
It  is,  however,  true  that  in  youth,  when  the  whole 
system  abounds  in  vigour  and  strength,  much  super- 
fluous food  may  be  disposed  of— first,  by  the  greater 
activity  of  the  functions  of  digestion  and  absorption  ; 
and  secondly,  by  the  capacity  youth  possesses  for 
excessive  muscular  exertion,  by  which  it  can  use  up 
and  eliminate  such  excess,  almost  at  will. 

"But  the  neglect  to  adjust  a  due  relation  between 
the  '  income '  and  the  '  output '  cannot  go  on  for  an 
indefinite  period  without  signs  of  mischief  appearing 
in  some  quarter." 

Many  methods  of  eliminating  this  excess  of  food 
are  practised.  The  various  forms  of  muscular  ac- 
tivity involved  in  out-of-door  games  and  exercises, 
so  long  as  they  can  be  adopted  with  safety,  are  as 
valuable  as  they  are  popular ;  but  their  pursuit  is 
often  unwisely  protrjvcted  to  a  period  of  life  when 
they  are  no  longer  safe  or  useful,  and  it  is  then  th^t 


Chap.  XL]  Diet  /a  Training.  279 

the  eliminative  effects  of  the  Turkish  bath  or  of  an 
occasional  course  of  purgative  waters  find  their  appro- 
priate application. 

Of  late  years  a  habit  of  drinking  milk  as  a  bever- 
age at  meals  has  been  largely  adopted,  without, 
apparently,  reflecting  that  milk  is  a  highly  nutritious 
fluid  food  which  has  the  property  of  becoming  solid 
when  it  meets  the  acid  gastric  juice;  and  a  lai-ge 
excess  of  solid  food  may  thus  inadvertently  be  taken. 
"  There  are  even  some  persons  who  must  wash  down 
their  ample  slices  of  roast  beef  with  draughts  of  new 
milk ! — an  unwisely-devised  combination  even  for 
those  of  active  habit,  but  for  men  and  women  whose 
lives  are  little  occupied  by  exercise  it  is  one  of  the 
greatest  dietary  blunders  which  can  be  perpetrated. 
It  is  altogether  superfluous  and  mostly  mischievous 
as  a  drink  for  those  who  have  reached  adult  age  and 
can  digest  solid  food."* 

The  quantity  of  food,  then,  required  in  adult 
life  will  be  conditional,  to  a  great  extent,  on  the 
habits  of  the  individual  with  regard  to  physical 
activity. 

And  this  brings  us  to  the  subject  of  "  training  " 
for  athletic  exercises,  a  process  which  has  for  its 
object  the  development  of  the  highest  degree  of 
strength  and  activity  attainable  by  the  human  body, 
so  as  to  enable  it  to  perform,  without  injury  to  itself, 
feats  involving  great  or  protracted  exertion.  In  this 
process  some  loss  of  weight,  some  loss  of  stored-up 
redundant  niaterial,  almost  invariably  takes  place. 
If  this'^  is  carried  too  far,  the  subject  is  weakened 
instead  of  sti*engthened,  and  he  is  said  to  be  "over- 
trained." If  it  is  not  carried  far  enough,  and  the 
subject  remains  encumbered  and  embarrassed  with 
useless  fat  or  other  unnecessary  material,  he  is  said 
to  be  "  undei'-trained."  The  competent  and  esperi- 
enced  trainer  endeavours  to  hit  oft"  the  happy  medium, 
•*  the  exact  and  precise  balance  between  the  two 
conditions." 
*  Sir  H.  Thompson  :  "  Diet  in  Relation  to  Age  and  Activity." 


28o  Food  in  Health.  fPan  i. 

Training  usually  involves  a  combination  of  diet 
and  exercise,  and  a  period  of  six  weeks  is  usually 
devoted  to  the  process.  When  properly  carried  out, 
it  is  attended  with  a  loss  of  fat  and  water  and  an 
increase  both  vx  bulk  and  firmness  of  the  muscles  ; 
and  this  is  accompanied  by  a  feeling  of  lightness 
and  freedom,  and  "  fitness  "  for  exertion.  The  skin 
especially  improves  in  appearance,  and  should  become 
"clear,  smooth,  fresh-coloured  and  elastic."'  It  used 
formerly  to  be  the  custom,  now  abandoned  as  injurious, 
to  begin  a  coui'se  of  training  by  an  emetic  and  repeated 
saline  purges.  The  transition  from  the  usual  diet 
should  not  be  too  sudden,  but  duly  graduated,  and  the 
food  selected  should  be  palatable  and  digestible. 

Lean  meat  always  enters  largely  into  the  diet  of 
training,  for  it  has  been  established  that  a  meat  diet 
leads  to  the  removal  of  superfluous  water  and  fat, 
lessens  weight,  and  imparts  firmness  and  endurance 
to  the  muscles.  Beef  and  mutton,  roa.stor  grilled  and 
"underdone,"  are  usually  preferred.  Toast  or  stale 
bread,  and  a  moderate  quantity  of  potatoes  and  green 
vegetables,  especially  watercresses,  are  allowed.  All 
entr«^es,  all  puddings  and  pastry,  are  strictly  for- 
bidden, as  are  all  sauces,  pickles,  and  condiments  ; 
the  object  being  to  preserve  or  develop  a  simple, 
natural  appetite,  and  not  provide  food  which  may 
provoke  to  excess. 

To  meet  the  loss  of  water  from  the  body  involved 
in  active  exertions  a  certain  amount  of  fl\iid  must  be 
taken;  but  it  is  usual  to  limit  this  with  some  care, 
and  only  sufficient  to  allay  thirst  should  be  taken, 
and  this  should  be  slowly  sipped,  any  excess  of 
drink  being  injurious.  Barley-water,  toast-and-water, 
tea,  coffee,  and  cocoa  are  permitted,  as  well  as  a  little 
beer  or  light  wine.     No  spirits. 

Only  three  meals  a  day  should  be  taken  :  one  at 
8.30  or  9  a.m.  ;  the  second,  about  1  or  2  p.m.  ;  and 
a  supper  between  8  and  9  p.m.  After  the  period  of 
training  is  over  the  transition  to  the  ordinary  habits 
(if  feeding  should  again  l)e  easy  and  gradual. 


Chap.  XL] 


Diet  in  Training. 


281 


Maclaren  gives  the  following  schemes  of  training 
as  carried  out  at  Oxford  and  Cambridge  : — 


A  Day's  Training  foe  the  Summer  Racbs. 


Oxford. 

7  a.m.— Rise.  A  short  walk 
or  run. 

8.30  a.m. — Breakfast  of  un- 
derdone meat,  crust  of  bread, 
or  dry  toast,  tea  (as  little  as 
possible). 

2  p.m. — Dinner,  meat  (as  at 
breakfast),  bread,  no  veget- 
ables (not  strictly  adhered 
to),  1  pint  of  beer. 

6  or  5.30  p.m. — Rowing  exer- 
cise. 

8.30  or  9  p.m. — Supper,  cold 
meat  or  bread,  sometimes 
jelly  or  watercresses,  1  pint 
of  beer. 

10  p.m.— Retire  to  bed. 


dambridge. 

A  run  of  100  or  200  yards  as 
fast  as  possible. 

Underdone  meat,  dry  toast, 
tea,  2  cups  (later  only  1^), 
watercress  (occasionally) 

Meat  (as  at  breakfast),  bread, 
potatoes,  and  greens,  1  pint 
of  beer.  Dessert — oranges, 
or  biscuits  or  figs,  2  glasses 
of  wine. 

Rowing  exercise. 

Cold  meat,  bread,  lettuce,  or 
watercresses,  1  pint  of  beer. 


A  Day's  Training  for  the  Winter  Races. 


Oxford. 
a.m. — Rise. 


A     short 


7.30 

walk  or  run. 

9  a.m. — Breakfast,  as  in  sum- 
mer. 

1  p.m. — Luncheon,  bread  or  a 
sandwich,  and  J  pint  of 
beer. 


2  p.m. — Rowing  exercise. 

5  p.m. — Dinner,  meat  as  in 
summer,  bread,  same  rule  as 
in  .summer  as  to  vegetables, 
rice  pudding  or  jelly,  and 
J  pint  of  beer. 

10  p.m — Retire  to  bed. 
Water  strictly  forbidden. 

As  little  liquid  to  be  drunk  as 
possible. 


Cambridge. 

7  a.m. — Exercise  as  for  sum- 
mer races. 

8.30  am. — Breakfast  as  in 
summer. 

A  littlt>  cold  meat,  bread,  and 
J  pint  of  beer,  or  biscuit 
and  glass  of  sherry  (some- 
times yolk  of  egg  in  the 
sherry). 

Rowing  e.xercise. 

5  to  6  p.m. — Dinner,  as  in 
summer. 


282  Food  in  Health.  [Parti. 

Adults  whose  lives  are  necessarily  and  chiefly 
devoted  to  intellectual  or  other  sedentary  occupations 
should  not  attempt  to  consume  the  same  amount  of 
food  as  those  whose  duties  or  pursuits  involve  much 
physical  activity  in  the  open  air.  The  kinds  of  food 
they  take  may  also  frequently  be  modified  with  ad- 
vantage. The  substitution  of  fish,  to  some  extent, 
for  butcher's  meat  has  much  to  recommend  it  in 
these  individuals.  It  is  not  so  rich  in  nitrogenous 
substances  as  butcher's  meat,  and  does  not  throw 
so  much  work  on  the  eliminating  functions  ;  and  the 
lighter  kinds  are  much  easier  of  digestion.  There  is, 
however,  no  foundation  for  the  popular  view  that  fish 
contains  elements  wliich  adapt  it  in  a  special  manner 
to  be  a  "  brain-food "  or  to  sustain  and  promote 
intellectual  labour. 

Brain-\torkfirs_sh.ould  live  much  on  light  food  not 
demanding  much  effort  of  the  stomach  to  digest,  and 
they  should  remember  that  the  digestion  of  heavy 
meals  involves  also  a  greater  expenditure  of  nerve- 
force.  Besides  fish,  eggs,  milk,  light  porous  well- 
made  bread,  fresh  vegetables  and  fruit  should  form 
their  chief  sustenance.  They  should  take  only  a  small 
amount  of  butcher's  meat,  and  that  especially  on  those 
occasions  when  they  are  able  to  take  more  physical 
exercise.  Some  animal  fat  is,  however,  useful,  such 
as  fresh  butter  or  cream,  or  a  rasher  or  two  of  fat 
bacon  at  breakfast.  It  is  a  remarkable  fact  that 
whei'eas  the  muscles  contain  only  three  per  cent,  of 
fat,  the  brain  contains  8  per  cent.,  and  the  nerves 
twenty-two  per  cent.  ;  and  this  "  high  percentage  of 
fatty  matters  contained  in  nervous  substances  indi- 
cates the  necessity  of  fat  for  the  proper  performance 
of  the  functions  of  the  nerves." 

Climate  and  temperature,  as  well  as  physical 
activity,  influence  also  the  quantity  and  quality  of 
the  food  required. 

It  is  well  known  that  in  tropical  countries,  as 
well  as  in  countries  where  they  have  prolonged  hot 
seasons,  as  in  the  south  of  Europe,  the  natives  live 


Chap.  XI.]  Climate  and  uiet.  283 

much  on  vegetable  foods  and  fruit,  when  these  can  be 
obtained,  and  consume  much  less  animal  food  and 
fatty  substances  than  the  natives  of  northern  Europe  ; 
whereas  in  Arctic  regions,  where,  it  is  true,  no 
vegetables  can  be  obtained,  the  inhabitants  consume 
enormous  quantities  of  animal  flesh  and  fat.  The 
necessity  of  supplying  the  body  with  a  large  propor- 
tion of  combustible  food,  such  as  hydro-carbons,  when 
the  external  tenipei'ature  is  very  low,  is  obvious ; 
and  it  is  equally  clear  that  very  little  food  of  this 
kind  is  needed  when  the  external  temperature  is 
high.  In  Britain  during  the  heat  of  summer  some 
modification  of  the  habitual  diet  should  be  made  ; 
less  animal  food  and  fats  should  be  consumed,  and 
more  vegetable  substances  and  fruit  should  be  taken 
in  their  place. 

Many  idiosyncrasies  with  regard  to  particular 
articles  of  food  have  to  be  considered,  not  only  in 
adult  life,  when,  however,  they  become  more  marked, 
but  at  all  ages.  Some  persons  cannot  digest  milk, 
others  cannot  take  eggs  in  any  form  :  some  can  eat 
no  fat  ;  some  are  made  ill  by  certain  kinds  of  fish,  etc. 
All  these  peculiarities  have  to  be  reckoned  with. 
These  are  sometimes  due  to  inherited  tendencies ; 
sometimes  they  are  tlie  growth  of  habit. 

Some  persons  do  best  with  long  intervals  between 
their  meals ;  their  digestions  are  slow.  Others  with 
quick  digestions  require  food  more  frequently.  Long 
fasts  are,  as  a  rule,  ill  homo  by  feeble  persons  who 
cannot  eat  largely  at  their  meals,  and  such  persons 
are  often  better  for  taking  a  small  quantity  of  food 
between  their  late  dinner  and  breakfast,  which  usually 
involves  a  fast  of  twelve  or  more  hours.  A  little 
light  food  on  going  to  bed,  or,  if  they  wake,  as  they 
are  prone  to  do,  in  the  night,  is  advisable.  This  may 
be  simply  a  cup  of  clear  soup,  or  beef-tea,  or  gruel, 
milk,  or  arrowroot. 

It  is  to  be  noted  also  that  women  require  less  food 
than  men,  as  their  bodies  are  usually  smaller,  and 
they  more  commonly  lead  inactive,  sedentary  lives. 


284  Food  in  Health.  [Pani. 

Tl\ey,  however,  pass  through  critical  periods,  which 
may  require  special  care  ;  e.<i.  after  repeated  profuse 
htemorrhage  at  tlie  menstrual  periods,  they  may 
require  a  diet  rich  in  albuminates  to  repair  the  losses 
caused  thereby.  It  has  already  been  pointed  out  that 
especial  provision  should  be  made  in  the  dietary  for 
the  special  calls  upon  the  system  wliich  pregnancy 
and  lactation  involve. 

Food  in  advanced  age. — Witli  advancing 
years  the  functional  activity  of  the  bodily  organs 
diminishes,  the  capacity  for  physical  exertion  is  con- 
siderably weakened,  and  the  mental  powers  usually 
begin  to  flag ;  the  functional  activity  in  the  digestive 
organs  partakes  in  this  general  decline,  so  that  while 
there  is  less  need  for  food  on  account  of  lowered 
physical  and  mental  activities,  tliere  is  also  less  power 
of  digesting  and  assimilating  food  on  account  of  the 
slowly  progressing  degenerative  changes  in  the 
secreting  glands  and  the  consequent  diminished  diges- 
tive and  absorbent  power  in  the  alimentary  canal. 
The  circidation  through  the  abdominal  organs  also 
tends  to  become  languid,  so  that  absorption  is  thereby 
delayed,  and  maybe  further  hindered  by  degenerative 
changes  in  the  blood-vessels  themselves.  Moreover, 
the  muscular  walls  of  the  intestine  lose  their  tone  and 
contractile  power,  and  there  is  a  tendency  to  dilatation, 
especially  of  parts  of  the  large  intestine,  causing  delay 
in  the  expulsion  of  the  residual  faeces,  so  that  con- 
stipation and  flatulence  tend  to  add  further  to  the 
embarrassment  of  the  digestive  functions. 

All  these  inevitable  changes  necessitate  appro- 
priate and  corresponding  changes  in  the  amount 
and  kind  of  food  taken. 

In  the  first  place,  the  food  must  be  diminished  in 
quantity.  Less  nutriment  must  be  taken  in  propor- 
tion as  age  advances  and  activity  diminishes,  other- 
wise fat  will  accumulate  or  symptoms  of  gout  or  rheu- 
matism, or  other  troubles  depending  on  defective 
elimination,  Avill  make  their  appearance,  and  may  be 
regai'ded     as   danger-signals.      The    "  intake "  must 


Chap.  XL]  Food  in  Advanced  Age.  285 

be  reduced,  because  a  smaller  expenditure  is  an 
enforced  condition  of  existence.  "  The  system  of 
'supporting'  aged  persons,  as  it  is  termed,  with 
increased  quantities  of  food  and  stimulants,  is  an  error 
of  cai'diual  importance,  and  without  doubt  tends  to 
shorten  or  to  embitter  life.  ...  As  age  increases 
the  ability  to  eliminate  food  unnecessarily  consumed 
notably  diminishes.  .  .  .  The  elderly  man  who 
desires  to  preserve  fair  health  and  to  attain  to 
longevity  should  gradually  diminish  liis  use  of  strong 
nitrogenous  and  much  fatty  food."* 

In  Sir  George  Humphry's  report  on  "  Centen- 
arians," published  in  the  reports  of  the  Collective 
Investigation  Committee  of  the  British  Medical  Asso- 
ciation,! it  appears  that  their  habits  in  the  matter 
of  eating  and  drinking  tended,  as  a  rule,  to  great 
moderation  in  both.  The  large  majority  were  small 
or  moderate  eaters.  Of  animal  food  the  majority 
took  but  little.  Of  thiity-eight,  three  took  none, 
four  took  very  little,  twenty  took  little,  ten  took 
a  moderate  amount,  and  one  only  took  much.  The 
exact  quantity  is  mentioned  in  nine  instances  :  one 
took  12  oz.,  one  6,  one  5,  and  six  4  oz.  daily.  In 
the  use  of  alcoholic  drinks  we  also  find  evidence  of 
great  moderation.  Fifteen  were  either  all  their  lives 
or  in  their  old  age  or  youth  total  abstainers  ;  twenty- 
two  took  but  little,  two  very  little,  ten  a  moderate 
amount  of  alcohol,  and  some  who  had  taken  a  little 
alcohol  formerly  were  taking  none  in  their  old  age. 
It  is  remarkable  how  numerous,  in  the  published 
records  of  centenarians,  are  the  references  to  the 
great  sobriety,  temperance,  and  '*  abstemious  "  habits 
of  the  inmiense  majority  of  persons  who  have  reached 
great  age,  and  especially  frequent  is  the  statement 
that  they  have  partaken  very  sparingly  of  animal 
food. 

It  has  been  pointed  out  by  several  writers  that  the 

•  Sir  Henry  Thoinpson  :  "Food  ami  Feeding." 
t  Vol.  iii.,  ISSr. 


286  Food  in  Health.  [Pani. 

disappearance  of  the  teeth  in  advanced  life  and  the 
loss  tiiereby  of  the  powers  of  mastication  seem  to  be 
associated  with  the  fact  that  foods  needing  mastication, 
such  as  animal  flesh,  are  inappropriate  to  this  period 
of  life,  and  that  the  softer  and  lighter  kinds  of  food 
not  needing  mastication  are  more  suitable  and  should 
be  had  recourse  to.  It  is  true  that  the  dentist's 
art  is  capable  of  replacing  the  lost  masticating 
organs,  but  if  these  artificial  teetli  are  used  for 
the  purpose  of  continuing  a  diet  largely  composed 
of  animal  flesh,  they  will  not  prove  an  unqualified 
advantage. 

"The  typical  man  of  eighty  or  ninety  years,  still 
retaining  a  respectable  amount  of  energy  of  body 
and  mind,  is  lean  and  spare,  and  lives  on  slender 
rations."* 

Great  caution,  however,  should  be  observed  in 
making  any  radical  change  in  the  diet  of  an  elderly 
person,  and  it  should  be  introduced  very  gradually. 

The  proportion  of  animal  to  vegetable  food  sliould 
not  be  more  tlian  one  part  of  the  former  to  three 
of  the  latter,  and  it  should  be  our  aim  to  reduce  even 
this  proportion.  As  the  amount  of  food  taken  at  one 
time  should  be  small,  it  is  necessary,  at  this  period  of 
life,  that  the  intervals  between  meals  should  be  some- 
what shortened,  and  the  meals,  therefore,  more  numer- 
ous. It  is  often  an  advantage,  for  this  reason,  for 
aged  persons  to  have  a  little  fluid  food  at  hand  during 
the  night,  to  be  taken  when  they  awake,  as  tliey  so 
often  do,  about  three  or  four  o'clock  in  the  morning. 
A  little  food  or  stimulant  taken  at  this  hour  will 
frequently  enable  them  to  fall  asleep  again. 

Large  heavy  meals  must,  then,  be  carefully  a\'oided, 
and  meals  consisting  of  a  small  or  moderate  amount 
of  easUy-digested  food  should  succeed  one  another  at 
not  too  long  intervals. 

Of  the  animal  foods  best  suited  for  this  time  of 
life,  the  following  may  be  mentioned.  When  the 
organs  of  mastication  are  altogether  inefficient,  these 
*  Sir  H.  Thompiion's  "Food  in  Relation  to  Age  and  Activity." 


Chap.  XI.]  Foods  Suitable  to  Advanced  Life.  287 

foods  should  be  minced  or  pounded  into  a  paste,  or 
otherwise  finely  subdivided  : — 

Young  and  tender  chicken  and  game,  and  other  tender  meats. 

Potted  chicken,  game,  and  other  meats.     Sweetbread. 

White  fish,  as  soles,  whiting,  smelts,  flounders,  etc.     Best  when 

boiled. 
Bacon,   grilled ;    eggs    lightly  cooked,    or    beaten    up    with 

milk,  etc. 
Kutritious  soups,  such  as  chicken  purees,  or  fish  purees,  beef- 

tea,  mutton,  and  chicken  broths. 
Milk  in  all  forms  when  easily  digested. 
Beef-tea  and  milk  supply  the  needed  mineral  substances,  and 

the  former  is  an  excellent  stimulant. 
The  addition  to  milk  of  an  equal  quantity  of  Vichy  water, 

warm,  or  of  warm  water,  will  often  help  to  make  it  agree. 

Of  vegetable  foods  the  following  are  all  suitable : — 

Bread-and-milk  made  with  the  crumb  of  stale  bread,  and 
without  any  lumps. 

Porridge  and  oatmeal  gruel. 

Puddings  of  ground  rice,  tapioca,  arrowroot,  sago,  macaroni, 
with  milk  or  eggs,  and  flavoured  with  some  warm  spices, 
or  served  with  fruit-juice  or  jelly;  bread  and  butter,  the 
bread  at  least  a  day  old ;  rusks,  for  soaking  in  tea  or  milk 
and  water. 

Artificial  foods,  consisting  of  pre-digested  starches  ;  the  digested 
ferments  are  scantily  provided  by  the  digestive  organs  at 
jthis  age,  and  soluble  carbo-hydi"ates  are  valuable  for  main- 
taining the  body-heat. 

All  fariuaceous  foods  should  be  submitted  to  a  high  temperature 
for  some  time,  so  as  to  render  the  starch  granules  more 
easy  of  digestion. 

Vegetable  piiries  of  all  kinds  may  be  taken  in  moderation,  e.g. 
potatoes,  carrots,  spinach,  and  other  succulent  vegetables. 

It  is  impoi-tant  that  the  use  of  potatoes  and  fresh  vegetables 
should  not  be  neglected,  otherwise  a  scorbutic  state  of  the 
body  may  be  engendered. 

Stewed  celery  and  stewed  Spanish  or  Portugal  onions. 

Stewed  or  baked  fruits  and  fruit  jellies,  and  the  pulp  of  per- 
fectly ripe  raw  fruits  in  small  quantity. 

The  acidity  of  certain  stewed  fruits  may  advan- 
tageously be  neutralised  by  the  addition  of  a  little 
bicarbonate  of  soda,  so  as  to  avoid  the  use  of  a  large 
quantity  of  cane-sugar  to  sweeten  it,  as  this  is  apt  to 


288  Food  in  Health.  [Pan  i. 

cause  gastric  fermentation  and  acidity.  In  stewing 
fruit,  about  as  much  soda  as  will  cover  a  shilling 
should  be  added  to  each  pound  of  fruit. 

Aged  persons  often  require  their  foods  to  be 
accompanied  with  some  kind  of  condiment  which 
promotes  their  digestion  and  prevents  flatulence. 

Caviare  and  the  roes  of  smoked  and  salted  herrings 
are  of  this  nature. 

For  sweetening  food,  milk-sugar  is  much  less 
prone  to  excite  acid  fermentation  than  cane-sugar. 

A  very  digestible  form  of  fat — when  it  is  needed 
— is  cream,  mixed  with  au  equal  quantity  of  hot 
water,  with  about  ten  drops  of  sal-volatile  to  each 
fluid  ounce. 


jig 


CHAPTER  XII. 

THE    RELATIVE     ADVANTAGES     OP     ANIMAL     AND    VEGET- 
ABLE    FOODS — VEGETARIANISM. 

All  the  alimentary  substances  needed  for  the  nutri- 
tion and  sustenance  of  the  body  can  be  obtained 
either  from  the  vegetable  or  the  animal  kingdom. 
Albuminates,  carbo-hydrates,  fats,  and  mineral  sub- 
stances, identical  in  nature  and  composition  with 
those  which  are  found  in  the  animal  body,  are  to  be 
derived  also,  as  we  have  seen,  from  vegetable  products. 
There  is,  however,  a  considerable  difference  in 
their  assimilability  in  the  alimentary  canal.  Albu- 
minates (and  fats  also)  derived  from  animal  sources 
— as  in  flesh,  eggs,  milk,  etc. — are  almost  entirely 
and  rapidly  absorbed  in  the  stomach  and  intestine ; 
whereas  the  albumen  of  vegetable  substances  is 
generally  found  in  association  with  relatively  large 
quantities  of  starch,  and  these  are  enclosed  in  a  net- 
work of  cellulose  which  is  excessively  resistant  to  the 
action  of  the  digestive  juices  ;  and  it  has  been  cal- 
culated that  while  only  3  per  cent,  of  the  albumen 
of  animal  food  escapes  digestion  and  is  lost  in  the 
evacuations,  as  much  as  17  per  cent,  of  the  albumen 
of  vegetable  foods  is  thus  wasted.  If,  then,  a  man 
were  to  consume  only  as  much  vegetable  food  as 
would  afford  the  actual  amount  of  albumen,  salts, 
and  starches  necessary  to  cover  the  daily  losses  of 
the  body,  inasmuch  as  a  large  proportion  would  pass 
out  of  the  body  unutilised,  because  undigested,  the 
portion  appropriated  would  not  suffice  for  the  susten- 
ance of  the  body.  It  is  necessary  to  consume  a 
much  larger  quantity  of  vegetable  than  of  animal 
food  in  order  to  obtain  the  necessary  amount  of 
nourishment. 


290  Food  in  Health.  [Pani. 

It  has  been  said  that  the  digestion  of  animal  food 
** taxes  the  stomach"  more  than  ordinary  forms  of 
vegetable  food.  It  seems  to  us  that  this  statement 
requires  great  qualification.  Apart  from  individual 
pecidiarities,  which  are  prone  to  interfere  in  the  con- 
sideration of  a  question  of  this  kind,  and  assuming 
the  existence  of  a  normal  healthy  condition  of  the 
adidt  digestive  organs,  we  believe  the  contrary  to  be 
the  case,  supposing  the  animal  food  to  be  taken  only 
in  equivalent  quantity  to  such  vegetable  foods,  calcu- 
lated according  to  the  amounts  of  nutritive  con- 
stituents they  respectively  contain. 

It  is,  however,  generally  admitted  that  the  diges- 
tion of  vegetable  food  is  a  much  more  complex  process 
than  that  of  animal  food  ;  and  we  accordingly  find  the 
alimentary  canal  in  herbivorous  animals  to  be  of  far 
greater  extent  than  in  carnivora. 

It  would  seem  also  that  the  nutrition  of  the 
body  undergoes  certain  modifications,  according  to 
the  proportions  in  which  animal  and  vegetable  sub- 
stances enter  into  the  composition  of  the  food.  An 
excess  of  animal  food  appears  to  increase  the  amount 
of  fibrin  in  the  blood,  to  add  to  its  richness  in 
corpuscular  elements,  and  to  augment  the  proportion 
of  ])hosphatic  and  other  mineral  constituents  ;  it  is 
also  said  to  confer  additional  firmness  and  tone  to  the 
muscles,  and  to  lead  to  the  disappearance  of  superfluous 
fat.  Vegetable  food,  in  excess,  tends,  on  the  contrary, 
to  increase  the  amount  of  fat  deposited  within  the 
body,  and  to  induce  obesity. 

The  experiments  of  Lawes  and  Gilbert  in  the 
feeding  of  animals  went  to  show  that  food  rich  in 
albuminates  tended  to  the  increase  of  muscle  and 
bone ;  and  it  is  a  matter  of  common  knowledge  that 
herbivorous  animals  show  a  far  greater  tendency  to 
the  deposition  of  fat  than  flesh-eaters.  We  especially 
select  hei'bivorous  animals  for  purposes  of  fattening ; 
and  even  camiivorous  animals,  if  restricted,  to  some 
extent,  to  vegetable  foods,  become  fatter. 

The    consumption   of    food   rich   in    nitrogenous 


Chap.  XII.]      Animal  and  Vegetable  Foods.      291 

constituents  appears  also  to  promote  oxidation  within 
the  body,  and  to  be  attended  by  a  greater  absorption 
of  oxygen  from  the  respiratory  organs  ;  and  it  is  prob- 
ably owing  to  its  determining  an  increased  oxidation 
of  the  fat  deposited  in  the  tissues  that  an  exclusive 
diet  of  animal  flesh  has  been  found  to  act  as  a  remedy 
for  obesity. 

The  urinary  excretion  is  increased  in  quantity  by 
animal  food,  and  the  amount  of  urea,  as  is  well 
known,  is  also  increased,  together  with  the  phos- 
phates and  sulphates.  An  animal  diet  tends  further 
to  increase  the  acidity  of  the  urine  ;  a  vegetable  diet 
to  render  it  alkaline.  The  urine  of  the  herbivora  is 
acid  during  fasting  and  alkaline  after  feeding.  The 
urine  of  the  calf  while  sucking  is  acid,  but  becomes 
alkaline  as  soon  as  it  begins  to  feed  on  grass.  Animal 
food  is  certainly  more  stimulating  than  vegetable 
food,  and  appears  to  satisfy  and  allay  the  cravings  of 
hunger  more  completely  and  for  a  longer  period.  The 
reason  of  this  probal:)ly  is  that  animal  albuminates 
are  digested,  and  to  a  great  extent  absorbed,  in  the 
stomach ;  they  remain  longer  in  that  organ  than 
vegetable  foods  (which  are  almost  entirely  digested  in 
the  small  intestine),  and  enter  more  quickly  into  the 
general  circulation,  so  that  their  sustaining  influence 
is  more  quickly  felt. 

It  is  said  with  regard  to  animals  that  they  are 
made  more  ferocious  by  animal  food,  and  that  the 
herbivora  are  less  combative  than  the  carnivora ;  and 
Liebig  has  related  of  a  bear  kept  in  the  Anatomical 
Museum  at  Giessen  that  it  was  of  quiet  and  gentle 
disposition  while  fed  entirely  on  bread,  but  became 
vicious  and  dangerous  after  a  few  days'  feeding  on 
meat ;  and  he  mentions  that  even  swine  grow  fierce 
and  will  attack  men  after  having  been  given  flesh 
food.  But  it  must  be  remembered  that  the  disposi- 
tion of  animals,  as  well  as  their  physical  state,  may 
be  altered  considerably  by  different  kinds  of  food, 
although  these  may  be  all  derived  from  the  vegetable 
kingdom.  A  young  horse,  if  fed  wholly  on  oats  and 
t2 


292  Food  in  Health.  [Pani. 

beans,  is  apt  to  display  qualities  of  temper  and  dispo- 
sision  wliich  it  would  not  show  if  kept  on  bran  mashes 
and  hay. 

There  are  few  persons  in  the  present  day  who 
advocate  the  practice  of  limiting  the  human  dietary 
to  substances  of  exclusively  vegetable  origin.  The 
majority  of  the  so-called  "  vegetarians "  of  modern 
times  adopt  no  such  exclusive  diet,  but  take,  together 
with  the  more  highlv  nutritive  forms  of  vegetable 
food,  such  typical  animal  foods  as  eggs,  milk,  cream, 
butter,  and  cheese.  They  object  only  to  animal  flesh. 
But  those  who  take  for  their  food  the  egg  and  the 
milk  prepared  by  animals  from  the  vegetable  sub- 
stances they  feed  on,  and  reject  only  animal  flesh, 
have  no  claim  to  call  themselves  "  vegetarians." 
They  feed,  as  has  just  boeu  said,  on  the  most  typical 
and  most  concentrated  of  animal  foods.  They  have 
a  sentimental  objection  to  killing  animals  for  food, 
and  they  found  upon  it  a  scheme  of  diet  which  we 
believe  to  be  utterly  impracticable  on  an  extensive 
scale,  and  irreconcilable  with  the  existing  state  of 
civilised  man,  not  so  much  on  strictly  physiological 
grounds  as  on  general  economical  considerations. 
There  can  be  no  objection  to  individuals  adopting 
any  kind  of  diet  which  they  may  find  answer  their 
needs  and  minister  to  their  comfort ;  it  is  only 
when  they  attempt  to  enforce  what  they  practise  on 
others  that  they  must  expect  to  encounter  a  rational 
opposition. 

Nor  is  it  safe  to  argue  that  a  particular  mode  of 
diet  is  good  for  the  race  simply  because  it  appears  to 
answer  the  wants  of  certain  individuals.  As  Sir  W, 
Roberts  has  justly  observed  :  "  The  effects  of  a  vege- 
tarian diet  would  only  be  gradually  developed,  and 
would,  probably,  not  be  fully  impressed  on  the  bodily 
and  mental  qualities  of  the  race  until  after  such  habite 
had  been  continued  through  two  or  three  successive 
generations,"  and  he  mentions  having  encountered 
at  Salford,  "  whei'e,  some  years  ago,  there  existed  a 
flourishing  colony  of  vegetarians,  a  tradition  to  the 


Chap.  XII.]  "Vegetarianism.^^  293 

effect  that  though  vegetarianism  might  suit  the 
parents,  it  was  bad  for  the  children";  and  he  testifies 
to  having  seen  "  some  striking  examples  in  that 
borough  which  appeared  to  indicate  that  this  tradition 
was  well  founded." 

But  there  exists  also  abundance  of  evidence  that 
a  purely  vegetable  diet  is  not  the  most  appropriate  for 
the  production  of  either  physical  or  intellectual  effort. 

Jules  B^clard  has  recorded  in  his  well-known 
text-book  on  Physiology  that  "  the  workmen  employed 
at  the  forges  of  Tarn  were  for  a  long  peiiod  fed  with 
vegetable  substances.  It  was  then  found  that  all  the 
workmen  lost,  on  an  average,  fifteen  days'  work  a 
year  on  account  of  exhaustion  or  illness.  In  1883, 
Mons.  Talabot,  deputy  of  La  Haute  Yienne,  took 
charge  of  the  forges.  Meat  was  then  made  an  import- 
ant part  of  the  diet.  The  health  of  the  men  after- 
wards improved  so  greatly  that  they  did  not  lose  more, 
on  an  average,  than  three  days'  labour  a,  yeai".  Animal 
food  produced  a  gain  on  each  man  of  twelve  days' 
work  a  year." 

It  has  also  been  stated  that  the  Italian  labourers 
from  Lombardy,  with  their  largely  vegetable  dietary, 
performed  much  less  work  when  engaged  in  piercing 
the  St.  Gothard  Tunnel  than  their  Swiss  co-labourers 
with  a  move  richly  animalised  scale  of  diet.  Soldiers 
campaigning  have  likewise  been  observed  to  lose 
health  and  fall  ready  victims  to  scurvy  and  diarrhoea 
if  they  have  been  compelled  to  live  on  farinaceous 
foods  solely.  The  great  Haller  submitted  himself 
for  many  days  to  an  exclusively  vegetable  diet,  with 
the  result  that  he  found  himself  more  muscularly 
feeble,  and  suffered  from  general  languor  and  a  great 
disinclination  to  intellectual  work  ;  and  we  have 
been  authoritatively  informed  that  one  of  the  most 
eminent  of  living  philosophical  writers  restricted 
himself  to  vegetable  food  for  three  months,  and  then, 
when  he  had  read  what  he  had  written  during  that 
period,  he  was  so  dissatisfied  with  the  work  that  he 
burnt  all  the  manuscript ! 


294  Food  in  Health.  [Parti. 

Professor  Gubler  believed  that  too  exclusively  veget- 
able a  dietary  tended  to  favour  calcareous  degeneration 
of  the  arteries,  as  it  introduced  into  the  blood  a 
relatively  larger  proportion  of  mineral  substances  than 
animal  food  ;  and  Dr.  Raymond  observed  numerous 
cases  of  atheroma  of  the  blood  vessels  in  a  convent 
of  ;;w?se-eating  monks ;  amongst  others  the  prior,  a 
man  of  only  twenty-two  years  of  age,  presented  con- 
siderable induration  of  the  arteries.  Dr.  Treille,  of 
the  French  Navy,  observed  a  great  many  cases  of 
atheromatous  degeneration  amongst  the  inhabitants 
of  Bombay  and  Calcutta,  whose  food  in  many  cases 
consists  almost  exclusively  of  rice.  Of  course,  in  these 
last  instances  other  factors  may  have  been  operative 
besides  the  character  of  the  food. 

Too  exclusively  vegetable  a  diet  is  also  said  to 
cause  accumulations  of  tartar  on  the  teeth  as  well 
as  a  tendency  to  phosphatic  gravel. 

If  ^?fe  look  to  the  history  of  the  human  race,  we  see 
that  man  has  been  guided  in  the  selection  of  his  food 
by  the  circumstances  and  conditions  with  which  he 
has  been  surrounded.  His  physical  organisation 
seems  peculiarly  adapted  to  enable  him  to  accommodate 
himself  to  such  food  supplies  as  he  may  be  able  to 
jjrocure,  without  regard  to  whether  they  are  derived 
from  the  animal  or  vegetable  kingdom. 

In  Arctic  regions,  where  no  vegetable  can  be 
procured,  man  lives  entirely  on  flesh  and  fat,  and 
in  hot  countries,  where  fruits  and  nutritious  vegetables 
abound  and  are  readily  procurable,  he  consumes  these 
largely.  But  it  is  a  common  error  to  suppose  that 
the  natives  of  all  hot  climates  live  to  a  great  extent, 
or  almost  exclusively,  on  vegetable  food;  wherever 
animal  food  can  be  leadily  procured,  it  is,  as  ia  rule, 
taken  as  food.  Of  the  Pampas  Indians,  who  live  in 
a  "  climate  which  is  burning  hot  in  summer,"  it  is 
recorded  that  "  tliey  have  neither  bread,  fruit,  nor 
vegetables,  but  subsist  entirely  on  the  flesh  of  their 
mares " ;  and  as  to  the  effect  of  such  a  diet,  Sir 
Francis  Head  testifies,  "  after  I  had  been  riding  for 


Chap.  XII.]     Neglect  of  Vegetable  Foods.       295 

three  or  four  months  and  had  lived  on  beef  and 
water,  I  found  myself  in  a  condition  which  I  can 
only  describe  by  saying  that  I  felt  no  exertion  could 
kill  me  "  ! 

The  Chinese  eat  tish  and  pork  with  their  rice,  the 
Japanese  eat  fowls  in  great  abundance,  and  the  flesh 
of  whales  is  a  very  common  food  in  several  places 
among.st  the  poorer  classes. 

The  Ainibs  who  inhabit  the  Nubian  desert  subsist 
entirely  on  animal  food  ;  the  Abyssinians  eat  largely 
of  raw  flesh.  As  to  the  food  of  the  East  African,  it  is 
stated  by  Burton  that  "  the  xVrabs  assert  that  in  these 
latitudes  vegetables  cause  heartburn  and  acidity,  and 
tliat  animal  food  is  the  most  dige.stible.  A  man  who 
can  afibrd  it  almost  confines  himself  to  fle.sh,  and 
considers  fat  the  essential  element  of  good  living."* 
Parkes  also  testifles  that  the  "  natives  of  some  of  the 
hottest  countries  in  the  world  take  immense  quantities 
of  both  fals  and  starches." 

Nothing  can  appear  clearer  than  that  man,  by  his 
organisation  and  by  the  varying  circumstances  and 
conditions  in  which  he  is  placed,  is  destined  to  be 
a  mixed  feeder.  He  can  exist,  when  absolutely 
necessary,  exclusively  on  animal  food,  and  he  can  also 
exist  when  equally  necessary  and  inevitable,  exclu- 
sively on  vegetable  food ;  but  in  those  parts  of  the 
world  in  which  he  reaches  the  highest  degree  of 
development  and  civilisation  and  culture  we  find 
him  a  mixed  feeder,  taking  a  portion  of  his  food  from 
the  animal  and  a  portion  from  the  vegetable  kingdom. 

But  although  we  regard  man  as  essentially  an 
omnivorous  animal,  we  are  by  no  means  disposed  to 
deny  that  at  the  present  time  and  in  England  the 
due  utilisation  of  vegetable  foods  is  much  neglected, 
and  that  there  is  far  too  great  a  tendency  amongst  the 
whole  of  the  population  to  rely  chiefly  on  animal 
products  for  food.  It  has  been  estimated  that  in  a 
suitable   mixed    dietary    not    more    than    one-fourth 

*  Pavy  gives  many  other  curious  statements  about  the  food  of 
different  nations  and  races  in  "  Food  and  Dietetics." 


296  Food  in  Health.  [Pani. 

should  consist  of  animal  food  ;  if  this  proportion  is 
greatly  exceeded  an  undue  tax  is  imposed  on  the 
excreting  organs  to  eliminate  the  products  of  the 
transformation  of  the  nitrogenoxis  excess  thus  intro- 
duced into  the  body  ;  or  this  eliminatory  process  may 
be  imperfectly  accomplished  and  the  results  of  incom- 
plete or  abnormal  metamorphosis  of  superfluous  nitro- 
genous substances  may  increase  a  pre-existing  tendency, 
or  develop  one,  if  it  does  not  already  exist,  to  gouty 
or  other  kindred  disorders. 

It  would  certainly  be  an  unmitigated  gain — and  a 
great  advance  in  the  domestic  economy  of  the  poor 
and  labouring  classes  in  England — if  they  could  be 
taught  to  turn  to  better  account  than  they  do  the 
abundant  resources  of  nutritious  and  agreeable  food 
to  be  found  in  some  of  the  now  greatly  neglected 
vegetable  products  at  their  disposal.  The  absolute 
want  of  knowledge  amongst  the  wouien  of  this  class 
of  the  proper  methods  of  cooking  and  preparing 
vegetable  food  of  certain  kinds,  so  as  to  make  them 
into  appetising,  agreeable,  nutritious,  and  digestible 
dishes,  is  undoubtedly  the  chief  cause  of  their  wasteful 
neglect  of  these  foods — a  wastefulness  almost  'peculiar 
to  the  labouring  classes  of  England,  and  traceable 
probably  to  their  greater  command  of  supplies  of 
animal  food.  This  waste  is  especially  apparent  in 
their  treatment  of  green  vegetables,  vast  quantities  of 
which  are  thrown  away — namely,  all  the  outside  leaves 
of  lettuces,  cabbages,  etc. — which  in  another  country 
would  be  cleaned  and  trimmed  and  entirely  utilised 
as  wholesome  food. 

Sir  Henry  Thompson  especially  calls  attention  to 
the  value  of  the  haricot  bean,  as  one  of  the  best  of 
the  pulses  for  the  labotn-ing  classes,  and  exceedingly 
economical,  as  they  can  be  obtained  at  a  cost  of  2d. 
per  pound. 

His  directions  for  cooking  the  beans  are  aa 
follows  :  — 

"  Soak,  say,  a  quart  of  dry  haricots  in  cold  water 
for  about  twelve  hours,  after  which  i)lace  them  in  a 


Chap.  XII.]       Value  of  Vegetable  Foods.  297 

saucepan,  with  two  quartiS  of  ;;old  water  and  a  little 
salt,  on  the  fire  ;  when  boiling  remove  to  the  corner, 
and  simmer  slowly  until  the  beans  are  tender,  the 
time  required  being  about  two  or  three  hours.  (If 
the  water  is  hard,  a  little  soda  should  be  added  to 
soften  it.)  This  quantity  will  till  a  large  dish,  and 
may  be  eaten  with  salt  and  pepper.  It  will  be 
greatly  improved,  at  small  cost,  by  the  addition  of  a 
bit  of  butter,  or  of  melted  butter  with  parsley,  or  if 
an  onion  or  two  have  been  sliced  and  stewed  with 
the  haricots," 

Of  the  nutritive  value  of  the  haricot  he  justly 
adds  : — "  No  product  of  the  vegetable  kingdom  is 
so  nutritious ;  holding  its  own  in  this  respect,  as  it 
well  can,  even  against  the  beef  and  mutton  of  the 
animal  kingdom.  The  haricot  ranks  just  above  lentils, 
and  is  to  most  palates  more  agreeable.  By  most 
stomachs,  too,  haricots  are  more  easily  digested  than 
meat  is  ;  and,  consuming  weight  for  weight,  the  eater 
feels  lighter  and  less  oppressed,  as  a  rule,  after  the 
leguminous  dish  ;  while  the  comparative  cost  is  very 
greatly  in  favour  of  the  latter." 

No  one  has  done  more  than  Sir  Henry  Thompson 
to  disseminate  correct  views  as  to  the  relative  value 
of  animal  and  vegetable  foods,  or  to  enforce  the 
truth,  too  little  appreciated  at  present,  that  many 
of  our  more  troublesome  chronic  maladies  are  trace- 
able to  the  habitual  consumption  of  food  too  rich 
in  animal  albuminates.  His  remarks  onthis  subject 
are  so  just  and  pertinent  that  we  reproduce  them  here. 

"  The  vegetable  eater,"  he  observes,  "  pure  and 
simple,  can,  therefore,  extract  from  his  food  all  the 
principles  necessary  for  the  growth  and  support  of  the 
body  as  well  as  for  the  production  of  heat  and  force, 
provided  that  he  selects  vegetables  which  contain  all 
the  essential  elements  named.  But  he  must  for  this 
purpose  consume  the  best  cereals,  wheat  or  oats  (or 
maize);  or  the  legumes,  beans,  peas,  or  lentils  ;  or  he 
must  swallow  and  digest  a  large  weight  of  vegetable 
matter  of  less  nutritive  value,  and  therefore  containing 


298  Food  in  Health.  [Pani. 

at  least  one  element  in  excess,  in  order  to  obtain  all 
the  elements  he  needs.  Thus  the  Irishman  requires 
for  his  support  10  to  11  lb.  of  potatoes  daily,  which 
contain  chiefly  starch — of  which,  therefore,  he  consumes 
a  superfluous  quantity — very  little  nitrogen,  and 
scarcely  any  fat;  hence  he  obtains,  when  he  can, 
milk,  lard,  or  bacon,  or  a  hen-ing,  to  supply  the 
deficiency.  The  Highlander,  living  mainly  on  oat- 
meal, requires  a  much  smaller  weight,  since  his  grain 
contains  not  only  starch,  but  much  nitrogen  and  a 
fair  amount  of  fat,  although  not  quite  sufficient  for 
his  purpose,  which  is  usually  supplied  by  adding 
milk  or  a  little  bacon  to  his  diet.  On  tlie  other  hand, 
the  man  who  lives  chiefly  or  largely  on  flesh  and 
eggs,  as  well  as  bread,  obtains  precisely  the  same 
principles,  but  served  in  a  concentrated  form,  and 
a  weight  of  2  or  3  lb.  of  such  food  is  a  full  equivalent 
to  the  Irishman's  10  or  11  lb.  of  potatoes  and  extras. 
The  meat-eater's  digestion  is  taxed  with  a  far  less 
quantity  of  solid,  but  that  very  concentration  in  regard 
of  quality  entails  in  some  stomachs  an  expenditure  of 
force  in  digestion  equal  to  that  required  by  the  veget- 
able eater  to  assimilate  his  much  larger  portions. 
And  it  must  be  admitted,  as  a  fact  beyond  question, 
that  some  persons  are  stronger  and  more  healthy  who 
live  chiefly,  or  altogether,  on  vegetables  ;  while  there 
are  many  others  for  whom  a  proportion  of  aniuial 
food  appears  to  be  desirable,  if  not  nece.ssary." 

"Englishmen  consume  too  much  animal  food, 
particularly  the  flesh  of  cattle.  For  all  who  are 
occupied  with  severe  and  continuous  mechanical 
labour,  a  mixed  diet,  of  which  cereals  and  legumes 
form  a  large  portion,  and  fish,  a  little  fat  meat,  bacon, 
or  lard,  eggs  and  milk  form  a  moderate,  but  constant 
propoi-tion,  is  more  nutritious  and  wholesome  than 
almost  entirely  animal  food.  For  those  whose  labour 
is  chiefly  mental,  and  whose  muscular  exercise  is 
inconsiderable,  still  less  of  concentrated  nitrogenous 
food  is  desirable."* 

*  "  Food  and  Feeding,"  pp.  21-27. 


Chap.  XII.]      Evils  Attending  Animal  Food.      299 

It  has  been  suggested  that,  amongst  other  evils 
attending  an  animal  dietary,  one  is  that  it  favours  the 
tendency,  where  it  exists,  to  the  development  of 
cancer,  just  as  it  promotes  gouty  manifestations  in 
these  who  are  constitutionally  predisposed  to  such 
maladies.  Indeed,  Dr.  F.  W.  Beneke  has  introduced 
a  sjjecial  diet  for  the  treatment  of  cancer,  to  which  we 
shall  refer  in  the  second  part  of  this  work,  in  which 
nitrogenous  food  i«  reduced  to  a  miniuiuua. 


END   OF    PART  I- 


300 


part  H. 

FOOD    m    DISEASE. 

In  almost  every  period  in  the  history  of  medicine 
the  importance  of  dietetics  in  the  treatment  of 
disease  has  been  universally  recognised  ;  but  at 
no  period  has  the  therapeutics  of  food  obtained  so 
careful  a  study  and  so  wide  an  application  as  in 
the  present  day.  Our  more  complete  knowledge 
of  the  processes  of  digestion  and  metabolism  as 
they  occur  in  health,  and  of  their  disturbances  in 
disease  ;  our  enlarged  and  more  accurate  acquaint- 
ance with  the  cliemical  composition  of  alimentary 
sub.stances,  as  well  as  of  their  purposes  in  nutri- 
tion, have  contributed  greatly  to  the  growth  and 
development  of  this  branch  of  tlierapeutics. 

In  the  management  of  all  morbid  conditions  a 
suitable  adaptation  of  the  food  to  the  altered  state 
of  the  organism  is  of  the  highest  importance.  In 
none  is  it  of  more  consequence  than  in  the  treat- 
ment of  acute  diseases.  There  was  a  tendency  at 
one  time  to  limit  injuriously  the  dietary  of  fever 
patients  ;  the  tendency,  in  the  present  day,  is  un- 
doubtedly to  err  in  the  other  extreme.  In  no 
department  of  medical  practice  is  judicious  dis- 
crimination of  so  much  consequence. 

In  the  administration  of  food  in  disease  we 
have  to  pay  especial  regard  to  the  state  of  the 
digestive  and  assimilative  organs  as  influenced  by 
the  existing  pathological  processes. 

In  many  diseases,  indeed  in  all  febrile  diseases, 
while  the  tissue-waste  is  increased  and  the  need, 
therefore,  for  food  apparently  augmented,  the  capacity 
for  digesting  and  appropriating  nutriment  is  greatly 


Food  in  Disease.  301 

impaired  ;  and  if  in  our  eagerness  to  supply  food  to 
compensate  for  the  waste  of  tissue  we  lose  sight  of 
the  CO- existing  disability  of  the  digestive  and  assimi- 
lative processes,  we  shall  not  only  fail  in  the  object 
we  have  in  view,  but  we  shall  inflict  positive  injury 
on  our  patient. 

In  these  cases,  we  must  bear  in  mind  then,  that 
the  el iminative  processes  ai'e  usually  gravely  disturbed 
and  embarrassed,  and  the  exhibition  of  food  contain- 
ing much  that  cannot,  under  the  circumstances,  be 
utilised  and  annexed,  leads  to  still  further  elimi- 
native  difficulties. 

In  disearses  of  the  digestive  organs  themselves, 
acute  or  chronic,  we  must  ever  keep  present. in  our 
minds  this  disjibility,  and  remember  that  the  essen- 
tial conditions  of  alleviation  and  cure  of  such  dis- 
orders may  be  the  temporary  withholding  rather 
than  the  urging  of  food. 

In  other  instances,  where  progressive  bodily 
wasting  is  one  of  the  most  alarming  incidents  of 
the  disease,  our  ingenuity  should  be  wisely  directed 
to  devising  or  adopting  methods  of  feeding  which, 
while  they  do  not  overtax  the  functions  of  the  en- 
feebled digestive  organs,  tend  adequately  to  restore 
the  loss  of  tissue. 

All  these  conditions,  as  they  occur  in  connec- 
tion with  the  various  acute  and  chronic  diseases, 
will  meet  with  full  consideration  in  the  following 
chapters. 


302 


CHAPTER    I. 

FEEDING    IN   ACUTE    DISEASE    AND    CONVALESCENCE. 

It  is  scarcely  necessary  in  the  present  day  to  enter 
into  any  protracted  discussion  as  to  the  propriety  of 
feeding  or  of  withholding  food  from  patients  who  are 
suffering  from  febrile  maladies.  Since  the  time  when 
Graves  claimed  as  his  chief  title  to  the  gratitude  of 
posterity  that  "  he  fed  fevers,"  there  has  been  little 
Berious  inclination  to  go  back  to  the  starving  methods 
of  some  of  his  distinguished  predecessors  or  contem- 
poraries. To  "  feed  fever  "  is  now  the  popular  prac- 
tice, and,  in  many  instances,  it  is  carried  to  an 
injurious  excess. 

The  conclusion  of  some  of  the  older  physicians 
that  the  administration  of  food  tended  to  increase  the 
fever  in  cases  of  acute  disease,  rested,  no  doubt,  on 
some  basis  of  practical  observation,  and  we  are  well 
aware  now  that  the  careless  and  indiscreet  adminis- 
tration of  food,  unsuitable  either  in  quality  or 
quantity,  or  in  both,  is  most  harmful  in  febrile 
maladies. 

Cautious  and  careful  administration  of  food,  based 
on  the  principles  we  are  about  to  state,  will,  we 
believe,  be  found  most  in  accord  with  practical  experi- 
ence, as  well  as  with  scientific  experiment. 

It  is  a  univei*sally  acknowledged  fact  that  all 
febrile  states  are  accompanied  by  an  increased  waste 
or  consumption  of  the  tissues  of  the  body,  so  that 
there  occurs  a  considerable  loss  of  body-weight, 
usually  proportioned  to  the  intensity  and  duration  of 
the  fever. 

But  the  whole  of  this  loss  of  substance  is  not 
necessarily  due  to  the  febrile  process  alone,  whatever 
the  intimate  nature  of  that  process  may  be ;  a  portion 


Chap.  I.]         Feeding  in  Acute  Disease.  303 

of  it  is  undoubtedly  due  to  defective  nutrition  caused 
by  tlie  coincident  disorder  of  the  organs  of  digestion 
and  assimilation  which  almost  invariably  accompanies 
fever.  Not  only  is  there  absence  of  appetite  and  in- 
disposition to  take  food,  but  if  food  in  any  consider- 
able quantity  is  given  it  fails  to  be  digested  and 
assimilated,  and  by  accumulating  and  decomposing  in 
the  stomach  and  intestines,  only  serves  to  intensify 
the  febrile  process  and  increase  the  discomfort  of  the 
patient.  There  are,  therefore,  two  causes  of  waste 
co-operating  in  nearly  all  cases  of  acute  febrile  dis- 
order :  first,  the  abnormal  increase  of  the  metabolic 
processes,  especially  of  the  albuminous  tissues,  follow- 
ing as  a  direct  consequence  of  the  fever  itself ;  and, 
secondly,  the  defective  nutrition  dependent  on  the 
co-existing  morbid  changes  in  the  functions  of  the 
digestive  and  assimilative  organs. 

In  most  acute  and  severe  febrile  conditions  the 
activity  of  the  secreting  glands  of  the  stomach  and 
intestines  is  so  gravely  impaired  that  the  digestive 
powers  are  quite  unable  to  keep  pace  with  the 
destruction  of  the  tissues  ;  and  that  much  of  the 
waste  is  due  directly  to  the  febrile  process  seems  to 
follow  from  the  observation  that  the  excretion  of  urea 
by  a  fever  patient,  even  when  absolutely  deprived  of 
food,  will  sometimes  exceed  by  40  to  50  grammes 
that  of  a  healthy  man  with  an  ample  supply  of 
food.* 

It  has  also  been  remarked  that  in  chronic  forms  of 
fever,  attended  by  remissions  and  intermissions,  there 
is  less  waste  than  in  febrile  diseases  that  have  a  con- 
tinuous high  temperature,  and  that  in  cases  in  which, 
from  individual  peculiarity,  the  digestive  apparatus 
has  maintained  its  activity  (an  exceedingly  rare 
circumstance  in  continued  fevers)  the  loss  of  body- 
weight  has  been  inconsiderable. 

It  has  been  suggested  that  the  increased  albu- 
minous metabolism  observed  in  fever  is  due  wholly 
to  the  rise  of  temperature  ;  but  this  seems  negatived 
*  Bauer,  "  Dietary  of  the  Sick." 


304  Food  in  Disease.  [Pan  ii. 

by  the  observation  that  in  artificially  induced  septic 
fever  an  increased  excretion  of  urea  is  observed 
before  the  temperature  begins  to  rise,  nor  has  any 
constant  parallelism  been  observed  in  cases  of  fever 
in  the  elimination  of  urea  and  the  elevation  of  tem- 
perature. If  a  parasitic  microbe  is  the  exciting  cause 
of  the  fever,  it  may,  as  Germain  See  suggests,  be  the 
cause  both  of  the  wasting  and  the  high  temperature. 

After  the  decline  of  the  temperature,  especially  in 
those  diseases,  like  pneumonia,  which  end  in  a  crisis, 
the  increased  excretion  of  urea  not  only  continues, 
but  may  even  rise  still  higher  ;  and  this  circumstance 
is  regarded  by  some  as  due  to  the  accumulation  of  the 
products  of  albuminous  metabolism  in  the  body, 
during  the  fever,  in  such  quantity  that  some  con- 
siderable time  is  needed  for  their  elimination  ;  while 
others  maintain  that  it  is  due  to  the  causes  which 
originally  led  to  the  increased  metabolism  con- 
tinuing to  act  for  some  time  after  the  critical  fall  of 
temjierature  has  taken  place. 

Bauer  mentions  another  plausible  explanation 
that  has  been  suggested  of  the  large  increase  in  the 
elimination  of  urea  observed  during  the  stage  of 
resolution  in  cases  of  croupous  pneumonia,  viz.  that 
it  is,  in  part,  due  to  the  metabolism  of  the  albuminates 
of  the  fibrinous  exudation  in  the  process  of  absorp- 
tion. The  liquefaction  of  the  exudation  is  dependent 
on  fatty  degeneration,  and  the  nitrogenous  products 
of  the  splitting  up  of  the  albuminates  are  eliminated 
in  the  urine. 

Experimental  investigations  appear  to  show  that 
the  destruction  of  fat  does  not  keep  pace  with  the 
destruction  of  albuminates  in  fever,  so  that  the  visible 
emaciation  of  fever  patients  is  not  an  adequate  indi- 
cation of  the  waste  and  destruction  of  tissue  that  have 
taken  place.  It  has  been  established  by  Salkowsky 
that  during  fever  there  is  an  increased  elimination 
of  potash  salts  in  the  urine,  a  fact  which  points 
to  a  relatively  increased  waste  of  the  muscular 
tissues. 


Chap.  1.]         Feeding  in  Acute  Disease.  305 

We  may  conclude,  then,  that  one  of  the  most 
important  results  of  febrile  disease  is  the  augmented 
metabolism  of  the  albuminous  substances  of  the  body 
which  it  induces,  and  in  which  the  cellular  elements 
of  the  tissues  are  themselves  attacked  and  destroyed. 
It  follows  that  after  fever  has  existed  for  a  consider- 
able time,  the  voluntary  muscles,  and  even  the 
muscle  of  the  heart,  are  found  to  have  undergone  a 
kind  of  degeneration  ;  hence  the  great  muscular 
debility  which  is  so  prominent  a  symptom  in  patients 
recovering  from  febrile  maladies. 

The  principal  facts  to  be  borne  in  mind  in 
approaching  the  consideration  of  the  dietetics  of  fever 
are  these  : — 

1.  Associated  with  the  high  temperature  of  fever 
there  is  rapid  wasting  of  the  albuminous  tissues  ;  an 
augmented  consumption  (or  combustion)  of  the  struc- 
tural elements  of  the  body. 

2.  As  a  consequence  of  the  preceding,  there  is  an 
excessive  excretion  of  urea,  which  is  eliminated  in  the 
urine,  but  which  may,  for  a  time,  accumulate  in  the 
blood.  There  seems  to  be,  also,  although  to  a  less 
degree,  an  increased  excretion  of  carbonic  acid. 

3.  The  fats  do  not  appear  to  be  used  up  to  at  all 
the  same  extent  as  the  albuminates. 

4.  At  the  same  time,  the  functions  of  the  digestive 
and  assimilative  organs  are  gravely  disturbed.  There 
are  morbid  changes  affecting  the  peptic  and  other 
secreting  glands.  These  changes  are  usually  accom- 
panied by  loss  of  appetite,  and  even  disgust  for  food, 
and  inability  to  digest  solid  food,  which,  if  admin- 
istered, is  often  vomited. 

As  we  have  already  said,  it  used  to  be  taught  that 
the  administration  of  albuminous  food  in  fever  was 
injurious,  and  had  the  effect  of  intensifying  the  con- 
sumption of  the  tissues,  and  was,  in  short,  "pouring 
oil  on  the  fire "  ;  and  even  within  the  last  twenty 
years  it  has  been  attemj)ted  to  support  this  view  by 
experimental  observations.  As  they  were,  however, 
u 


3o6  Food  in  Disease.  iPartiL 

altogether  inconclusive,  it  is  not  necessary  to  quote 
them  here.  On  the  other  hand,  Bauer  and  Kiinstle, 
by  careful  observation  of  the  diet  of  typhoid  patients, 
have  comi)letely  established  the  fact  that  by  a  due 
"  su[)ply  of  albuminous  food  to  a  fever  patient  a 
saving  of  albumen  in  the  body  may  be  effected  ;  for, 
though  the  excretion  of  nitrogen  is  increased,  the  loss 
of  the  same  element  from  the  system  is  reduced."  * 
But  Bauer,  while  he  maintains  that  the  loss  of 
albumen  in  febrile  subjects  is  lessened  by  the  adminis- 
tration of  albumen,  yet  concludes  that  it  is  unlikely 
in  highly  febrile  states  it  can  be  entirely  prevented ; 
"  for,"  he  argues,  "  while  under  normal  conditions  a 
sort  of  equilibrium  is  constantly  maintained  between 
the  nutrient  fluids  and  the  tissues,  any  excess  of 
nutrient  material  being  speedily  removed,  partly  by 
increased  metabolism  and  partly  by  an  accession  of 
substance,  this  equilibrium  appears  to  be  more  or 
less  disturbed  in  fever. 

"  The  circulating  current  of  albumen  is  abnormally 
great  in  proportion  to  the  mass  of  cells  ;  but  the 
heated  cells  cannot  assimilate  this  excess,  since  they 
have  lost,  at  least  in  part,  the  capacity  for  taking  up 
and  turning  material  to  their  own  use.  A  nitro-^ 
genous  equilibrium  cannot  be  attained  in  patients 
with  high  fever,  even  if  they  were  in  a  condition 
to  absorb  large  quantities  of  albumen.  The  possi- 
bility of  compensating  the  loss  of  albumen  by  nourish 
ment  will  be  greater  if  the  fever  shows  more  or  less 
marked  remissions  or  intermissions,  because,  as  it 
seems  to  me,  the  cellular  elements  recover  during  the 
intervals  of  remission  the  power  of  adding  to  their 
substance  and  of  metabolising  the  excess  of  nutrient 
material." 

There  are  two  principal  rules  which  we  should 
always  keep  in  view  in  feeding  patients  with  febrile 
diseases  : — 

First,  to  endeavour  to  utilise  food  to  the  greatest 
extent  that  is  safe  and  possible  for  the  purpose  of 
*  Bauer,  "  Dietary  of  the  Sick." 


Chap.  I.]  Dietetics  of  Fever.  307 

checking  the  waste  of  tissue  which  is  associated  with 
the  febrile  process. 

SecoiuUy,  to  be  careful  to  administer  no  food  that 
cannot  be  readily  absorbed  and  assimilated  ;  for  if  we 
overlook  the  fact  that  tlie  functions  of  the  digestive 
organs  are  gravely  impaired  during  fever,  and  if,  in 
consequence,  we  give  food  that  the  patient  is  unable 
to  assimiiatej  this  undigested  food  will  decompose  in 
the  stomach  and  intestinal  canal,  and  cause  irritation 
of  the  gastro-intestinal  mucous  membrane  and  aug- 
ment the  febrile  movement. 

It  is  clear,  then,  that  there  is  need  for  great  dis- 
crimination in  dealing  with  individual  patients.  In 
cases  where  the  febrile  process  is  not  severe,  or  where 
there  are  distinct  remissions  or  intermissions,  and 
where  the  disturbance  of  the  digestive  organs  is  not 
considerable,  we  may  give  food  with  much  more 
freedom,  and  of  greater  variety,  and  in  larger  quan- 
tity than  in  cases  of  high  and  continued  fever,  with 
entire  loss  of  appetite,  and  obviously  great  disturb- 
ance of  the  functions  of  digestion  and  assimilation. 

It  is  especially  desirable  that  we  should  utilise 
periods  of  remission  in  febrile  diseases,  when  they 
occur,  for  the  more  liberal  administration  of  food,  as 
the  digestive  powers  are  more  active  during  these 
periods. 

There  is  one  other  preliminary  consideration  we 
must  also  bear  in  mind,  viz.  that  there  is  in  some 
cases  a  tendency  to  accumulation  in  the  body  of  the 
products  resulting  from  the  destruction  of  the  tissues ; 
and,  as  these  act  as  poisons  in  the  blood,  we  must  be 
careful  to  administer  such  food  as  shall  favour  their 
elimination,  and  not  lead  to  any  increased  accumula- 
tion in  the  body  of  nitrogenous  waste. 

Having  thus  jmssed  in  review  the  more  important 
principles  which  should  determine  the  alimentation  of 
patients  affected  with  acute  febrile  maladies,  we  may 
now  pass  on  to  the  consideration  of  the  best  means  01 
practically  applying  them. 
U2 


3o8  Food  in  Disease.  [Pan  ii. 

If  the  febrile  attack  is  an  acute  and  short  one — as 
is  seen,  for  example,  in  a  typical  case  of  croupous 
imeumonia  of  moderate  severity  and  with  early  crisis — 
there  is  no  need  for  any  anxiety  as  to  the  consump- 
tion of  much  food,  unless  old  age  or  previous  debility 
affords  a  special  indication  for  actively  supporting  the 
bodily  strength.  By  forcing  the  consumi)tion  of  a 
considerable  quantity  of  food  in  such  cases,  in  the 
absence  of  all  appetite  and  with  obvious  febrile  dis- 
turbance of  the  digestive  organs,  more  harm  than 
good  will  be  done. 

All  authorities  are  agreed  that  the  food  of  fever 
patients  should  be  in  the  fluid  form,  such  as  can  be 
readily  and  immediately  absorbed ;  that  it  should  be 
given  in  small  quantities  and  at  short  intervals. 

Sir  William  Roberts  observes : — "  In  forming  a 
plan  of  dietary  for  the  sick,  distinction  must  be  made 
between  gastric  and  intestinal  digestion.  In  healthy 
persons  and  invalids  of  the  slighter  sort,  we  must 
have  regard,  mainly  to  gastric  digestion ;  but  in  the 
seriously  sick  the  stomach  becomes  often  inoperative, 
and  digestion  becomes  almost  exclusively  intestinal. 
The  sympathy  of  the  stomach  with  the  general  con- 
dition of  the  system  is  much  more  active  and  close 
than  that  of  the  intestine ;  the  former  organ  approxi- 
mates more  nearly  to  the  animal  life  of  the  body, 
the  latter  more  nearly  to  the  vegetative  life.  The 
seriously  sick,  and  especially  the  febrile  sick,  are 
often  quite  unable  to  take  solid  food.  AVhen  the 
appetite  and  powei'  of  taking  food  fails,  it  fails  first 
with  regard  to  meat,  which  is,  so  to  speak,  the 
speciality  of  the  stomach,  and  next  in  regard  to 
bread.  Patients  are  then  reduced  to  the  use  of 
liquid  food :  milk,  beaten-up  eggs,  gruels,  jellies, 
beef-tea,  and  the  like.  In  this  latter  condition  the 
stomach  loses  its  normal  office,  and  becomes  merely  a 
conduit  to  pass  on  the  liquid  food  to  the  duodenum. 
Not,  perhaps,  that  there  is,  except  in  extreme  cases, 
an  absolute  abeyance  of  gastric  secretion  and  gastric 
action,  but  they  are  reduced  to  so  low  an  ebb  that 


Chap.  I.]  Of  the  Use  of  Milk.  309 

they  count  for  practically  nothing  in  the  work  of 
digestion."  * 

Milk  is  the  food  that  first  suggests  itself  to  our 
minds  as  most  suitable  for  fever  patients.  It  is  a 
complete  food,  i.e.  it  contains  all  the  elements  needed 
for  the  nutrition  of  the  body  :  albuminates,  fats, 
carbo  hydrates,  and  salines  ;  it  is  fluid,  and  it  is  re- 
latively cheap,  and  always  readily  procurable. 

There  is,  however,  one  great  drawback  to  the  use 
of  this  food  which  must  never  be  overlooked.  It  is 
quite  true  that  it  is  a  fluid,  out  of  the  body ;  but  it  is 
apt  to  coagulate  to  s.firvi  solid  within  the  alimentary 
canal,  and  this  solid  curd  may  pass  undigested  through 
the  whole  length  of  the  intestine,  and  set  up  much 
irritation  and  injury  in  its  course,  especially  in  cases 
of  typhoid,  where  there  always  exist  inflammation 
and  ulceration  of  the  mucous  membrane  of  the  in- 
testine. Patients  with  acute  disease  fed  mechanically 
and  carelessly  on  milk  will  often  be  found  to  evacuate 
from  the  bowels  masses  of  undigested  curd  ! 

You  will  find  also,  both  in  sickness  and  in  health, 
that  some  persons  digest  milk  with  difiiculty,  while 
others  digest  it  very  readily. 

The  great  convenience  of  milk  as  a  food  is  in 
itself  a  snare,  and  tends  to  induce  nurses  and  attend- 
ants to  think  no  evil  of  that  which  is  so  handy  and 
gives  so  little  trouble.  We  should,  therefore,  always 
be  on  the  watch  for  any  signs  of  indigestion  of 
milk  in  cases  of  acute  disease ;  and  in  these  cases 
milk  should  always  be  given  with  certain  pre- 
cautions. It  should  be  previously  boiled,  or  raised  to 
the  tem{3erature  necessary  for  sterilisation.  It  should 
be  given  diluted — either  with  water  or,  better  still, 
with  an  effervescent  alkaline  water  :  equal  parts  of 
milk  and  Vichy  or  Vals  water,  or  one  part  of 
milk  to  two  of  Apollinaris  or  soda-water ;  or  ten 
grains  of  bicarl)onate  of  soda  and  the  same  quantity 
of  common  salt  may  be  added  to  every  pint  of  milk 
and  water  (equal  parts).  Milk  thus  diluted  and 
*  "  Dietetics  and  Dyspepsia,"  p.  57. 


310  Food  in  Disease.  [Partii. 

mixed  with  alkali  can  often  be  absorbed  when  pure 
undiluted  milk  would  be  undigested.  As  a  fever 
patient  necessarily  requires,  as  we  shall  presently  see, 
much  water  as  a  beverage,  we  need  have  no  hesita- 
sion  in  freely  diluting  his  milk.  The  diluted  milk 
should  be  given  frequently,  in  small  quantities  at  a 
time.  Two  ounces  of  milk  with  two  ounces  of  alka- 
line water  every  hour  would  give  the  patient  two 
pints  and  a  half  of  milk  a  day,  and  a  fever  patient 
requires  a  drink  every  hour.  This  quantity,  of  course, 
may  be  increased  and  the  intervals  lengthened  in 
many  cases.  We  are  now  speaking  of  cases  in  which 
the  digestion  of  milk  is  difficult. 

In  instances  where  milk  even  tlius  diluted  appears 
to  disagree,  it  may  be  well  to  give  an  equivalent 
quantity  of  whey.  This  is  milk  from  which  the 
curd  and  much  of  the  fat  have  been  separated  by 
previous  coagulation  and  straining.  It  can  readily 
be  made  by  boiling  a  pint  of  milk  with  a  teaspoonful 
or  two  of  lemon  juice,  and  then  straining  through 
muslin  and  expressing  all  the  Huid  from  the  curd. 
If  the  curd  be  well  broken  up  after  coagulation  and 
all  the  fluid  thoroughly  pressed  out  of  it,  much  of  the 
fat  and  some  of  the  divided  casein  of  the  milk  will 
pass  into  the  whey,  and  thereby  much  increase  its 
nutritive  properties.*  This  may  be  made  more 
nutritious,  if  necessary,  by  adding  strong  beef- tea 
or  raw  meat  juice  to  it,  or  by  the  addition  of  an 
egg  previously  whipped  up  with  a  little  boiling  water 
and  strained. 

Bauer  t  recommends,  in  "  cases  in  which  cow's 
milk  cannot  be  tolerated  even  in  small  doses  and 
diluted,"  that  it  should  be  replaced  by  "  Nestl^'s 
Infants'  Food  and  similar  preparations,  or  Liebig's 
Food  for  Children." 

Eggs  form  another  complete  food  admissible  in 
most  febrile  maladies,     These  should  not  be  cooked, 

*  For  other  methods  of  making  whey,  see  Appendix, 
t  "Dietary  of  the  Sick," 


Chap.  1.]  yALUE    Ofi    EgGS,    ETC.  3II 

but  beaten  up  with  twice  oi'  three  times  as  much  hot 
(boiling)  water,  strained,  sweetened  with  sugar  or 
added  to  a  little  light  broth  or  clear  soup  {consomme). 
This  forms  a  very  nutritious  food. 

Or  the  yolk  of  an  egg  may  be  beaten  up  with  a 
little  hot  milk  and  water ;  or  with  a  little  hot,  weak 
tea,  sweetened  with  grape-sugar ;  or  eggs  may  be 
given  in  the  form  of  the  brandy  mixture  of  the 
British  Pharmacopceia.  (This  is  ordered  to  be  made 
by  rubbing  together  the  yolks  of  two  eggs  and  half  an 
ounce  of  refined  sugar,  and  adding  four  ounces  of 
cognac  and  four  ounces  of  cinnamon  water.  A  more 
generally  useful  mixture  may  be  made  with  half  this 
quantity  of  brandy.) 

Lightly-boiled  eggs,  or  eggs  beaten  up  in  hot 
broth,  have  been  given  in  typhoid  by  some  German 
physicians,  and  with  apparent  advantage,  but  English 
pliysicians  are  somewhat  more  cautious  in  feeding 
their  typhoid  patients. 

Most  important  and  largely  administered  foods  in 
febrile  diseases  are  the  various  meat  infusions,  juices, 
extracts,  etc ,  such  as  beef-tea,  solutions  of  beef,  meat 
extracts,  mutton,  veal,  and  chicken  broths,  clear 
soups  {consommes),  strong  and  weak,  and  variously 
flavoured  with  vegetable  juices. 

The  value  and  usefulness  of  these  foods  have  been 
almost  universally  admitted.  As  we  have  seen  the 
contrary  stated,  especially  with  regard  to  beef-tea,*  it 
may  be  as  well  to  quote  a  few  authoritative  opinions. 

Germain  See,  who  has  been  quoted  in  the  paper 
referred  to  as  if  he  were  an  opponent  of  beef-tea, 
mentions  the  following  as,  "  one  of  the  best  fluid 
foods "  :  t — Meat  cut  into  small  pieces,  cold  water 
added,  and  then  gradually  heated  to  140^  or  160°  Fahr. 
He  does  not  mention  what  relative  quantity  of  water, 
but  whether  much  or  little  it  is  essentially  the  same 
as  beef-tea.     Ho   points   out   also    that    it   contains 

*  British  Medical  Jcurnal,  Jan.,  1889,  p.  184. 

+  "Du  Regime  Alimentaire  :  Rt^gime  des  Fi^vreux,"  p.  385. 


312  Food  IN  Disease.  [Pan  ii 

important  salts — important  as  mineral  foods  —  especi- 
ally clilorides  and  sulphates,  combined  with  potassium. 

Subsequently  he  speaks  of  beef-tea  as  made  by 
placing  fragments  of  beef  in  a  hermetically  .sealed 
vessel,  and  exposing  them  for  several  hours  to  a  water- 
bath  ;  this  is  a  means,  as  he  points  out,  of  extracting 
all  the  gelatin  of  the  meat  "  It  is  true,"  he  goes  on 
to  say,  "  gelatin  by  itself  has  not  the  same  nutritive 
value  as  the  albuminates,  and  in  any  case  it  is  neces- 
sary to  prescribe  it  in  considerable  quantities  to  attain 
the  same  end.  We  may  do  so  with  impunity,  for  jellies 
are  well  tolerated  and  easily  digested.  But  in  reality 
these  are  only  auxiliary  means  of  conservation  of  our 
organic  tissues — des  moyens  d'epargne"  [a  means  of 
saving  the  tissues — what  could  be  more  important  in 
diseases  in  which  the  tissues  are  being  destroyed?]. 
"  From  this  point  of  view  gelatin  cannot  be  too  strongly 
recommended,  prepared  in  the  most  various  forms,  and 
with  a  variety  of  flavours." 

Again,  in  the  same  paper,  G.  Sde  is  quoted  as 
depreciating  beef-tea  to  the  advantage  of  milk.  This 
is  what  Prof.  See  says  of  milk  in  fevers  : — "  As  soon 
as  the  functions  of  the  stomach  are  disturbed,  milk 
digests  badly,  it  forms  clots  in  the  stomach  accessible 
with  dithculty  to  the  gastric  juice,  and  often  leaves 

that  organ  unpeptonised Although  we  may  then 

attempt  to  give  it  mixed  with  water,  or  Vichy  water, 
or  aerated  Avater,  or  even  with  some  alcohol,  or  cold, 
or  hot,  or  boiled,  or  raw,  the  patient  ends  by  refusing 
it,  and  the  physician  by  forbidding  it  /  "  * 

We  fear  the  author  of  the  paper  in  question  can 
only  have  consulted  Prof.  See's  works  with  the  desire 
to  find  therein  opinions  conformable  to  his  own. 

Bauer  also  exjiresses  his  approval  of  beef-tea  and 
strong  gelatinous  soups  as  food  for  fever  cases.  "  By 
the  addition  of  gelatin  in  proper  proportion  the  nutri- 
tive value  of  the  soup  is  greatly  increased,  without  the 
risk  of  imposing  any  further  burden  on  the  digestive 
organs.  Instead  of  clear  broth  we  may  use  beef-tea, 
*  "  Du  R4^me  Alimentaire  :  Regime  des  Fi^vreux,"  p.  384. 


Chap. I.]  Meat  Soups  and  Broths.  313 

which  always  contains  a  certain  amount  of  albuminous 
matter."*  "That  broth  and  meat  extract  contain  but 
very  small  amounts  of  actual  nutriment  in  no  way 
lessens  their  value  in  the  dietary  of  the  sick."t 

Dujardin-Beaumetz  maintains  that  the  most  suit- 
able diet  for  febrile  maladies  is  one  that  contains  only 
a  very  small  quantity  of  albuminous  matter,  and  that 
it  is  the  possession  of  saline  and  tonic  principles,  dis- 
solved in  a  large  amount  of  water,  which  constitutes 
the  chief  recommendation  not  only  of  broths  and  beef- 
tea,  but  also  of  milk.  "  For  my  part,"  he  says,  "  I 
consider  the  value  of  milk  in  febrile  maladies  is  due  to 
the  water  and  the  saline  substances  it  contains."  | 
And  again,  "  The  milk  and  broth  {bouillon)  we  give 
to  typhoid  patients  enable  us  to  administer  a  great 
quantity  of  water,  and  also  a  notable  quantity  of 
saline  matters  "  ;  and  he  refers  to  the  observations  of 
Robin  to  the  effect  that  in  typhoid  cases  there  is  a 
true  "mineral  inanition  resulting  from  the  daily 
losses  of  potash,  sulphuric  acid,  phosphoric  acid,  and 
chloride  of  sodium,  which  pass  away  in  the  urine  to 
the  amount  of  3  or  4  grammes  of  chloride  of  sodium, 
1'50  to  2  grammes  of  phosphoric  acid,  and  2967  of 
sulphuric  acid,  and  1"730  of  potash,"  and  he  compares 
this  with  the  following  analysis  of  "  bouillon  "  : — 


Water         985-600 

Organic  solids  left  after  desiccation  in  | 
vacuo  at  20°      ] 


16-917 


Soluble  S:ilts,  Chlorides,  Phosphates,  and  \  in -too 

Sulphates  of  Potassium  and  Sodium  ...  ) 

Salts  very  slightly  soluble — Phosphates  1  0-539 

of  Lime  and  Magnesia...         ...         ...  ) 

1013-776 

Practical  experience  seems  to  show  that  albuminous 
and  gelatinous  fluids,  when  they  are  not  disagreeable 

*  "  Dietary  of  the  Sick,"  p.  228.     Von  Ziemssen's  "  Handbook 
of  General  Therapeutics." 

t  "Dietary  of  the  Sick,"  p.  84. 

X  "  Du  Regime  Alimeutaire  dans  les  Maladies  Febriles,"  p.  225. 


514  Food  IN  Disease.  [Panii. 

to  the  fever  patient — and  it  is  an  inipoi*tant  matter  to 
consult  the  inclinations  and  disinclinations  of  the  sick 
— tend  to  support  the  bodily  strength,  and  lessen  the 
risk  of  exhaustion  ;  and  we  may,  therefore,  recommend 
in  such  cases  either  well-made  clear  soups  and  broths, 
or  the  stronger  beef-essences  and  beef-tea. 

It  is  an  error  to  give  these  preparations  of  beef 
in  too  concentrated  a  form,  in  which  they  often  prove 
repugnant  to  the  sick;  and  seeing  how  needful  it  is  to 
give  considerable  quantities  of  water  to  fever  patients, 
there  can  be  no  good  reason  why  some  of  the  water 
should  not  be  taken  mixed  with  the  other  constituents 
of  soup.  Too  little  attention  has  also  been  given  to 
the  flavouring  of  the  food  of  febrile  patients.  In  the 
preparation  of  light  clear  soups  it  is  easy,  and  indeed 
beneficial,  to  add  some  flavouring  of  aromatic  hei'bs ; 
and  Sir  W.  .Tenner  long  ago  directed  attention  to  the 
error  that  is  committed  in  omitting  to  add  to  such 
soups  some  vegetable  juices.  It  is  quite  practicable 
to  give  clear  soups  whicli  shall  contain  a  considerable 
quantity  of  the  expressed  juice  of  fresh  vegetables. 
By  cooking  such  vegetables  as  carrot,  turnip,  celery, 
parsnip,  endive,  lettuce,  etc.,  together,  with  some 
aromatic  herbs,  such  as  parsley,  mint,  thyme,  or 
tarragon,  etc.,  cutting  them  fine,  and  placing  them 
in  a  muslin  bag,  then  boiling  and  expressing  the  juice 
into  the  soup — by  doing  this  the  soup  or  broth  can 
be  largely  mixed  with  the  juices  of  fresh  vegetables, 
an  important  and  wholesome  article  of  diet.  We 
have  often  found  a  well-made  Julienne  soup,  from 
which  the  vegetables  have  been  removed  by  straining, 
very  acceptable  to  febrile  patients. 

The  object  of  such  a  nitrogenous  diet  has  been 
misapprehended  by  some  of  those  who  have  argued 
against  it ;  it  has  been  said  that  it  is  useless  to  expect 
in  acute  fevers  that  albuminous  foods  can  be  utilised 
for  the  purpose  of  tissue  formation  ;  they  are  not  given 
with  that  object,  they  are  given  to  check  tissue-waste 
— to  spare  the  tissues,  or,  to  use  the  excellent  French 
expression,  as  moyens  (Tepargne — and  that  they  do  act 


Chap.  I.]  Dietetics  of  Fever.  315 

in  that  way  practical  observation  has  abundantly 
testified. 

G.  S6e  i"ecommends  that  in  prolonged  cases  of 
typhoid  we  should  add  to  the  meat-soups  some  'pul'p 
of  meat,  made  by  taking  raw  meat,  depriving  it  of 
all  its  fat  and  fibrous  structures,  scrajnng  it  fine, 
and  pressing  the  pulp  through  a  coarse  sieve;  from 
one-half  to  three-quarters  of  an  ounce  of  this  should 
be  given  at  a  time,  mixed  with  a  cup  of  broth  or 
clear  soup ;  but  in  those  grave  cases  where  we  find 
the  digestive  power  to  be  wholly  absent,  this  is  not 
a  desirable  food,  as  when  not  digested  it  decomposes 
readily. 

Cold  meat  jellies  and  calf's-foot  jellies,  when  ap- 
proved of  by  the  patient,  may  be  given  in  moderate 
quantities. 

Farinaceous  foods  containing  carbo-hydrates  — 
starch,  sugar,  etc. — can  be  suitably  administered  in 
various  fluid  forms.  Thin  oatmeal  or  barley  gruel, 
carefully  strained  from  all  gritty  particles,  and  flav- 
oured with  salt  or  grape-sugar  and  any  agreeable 
spice — as  lemon-peel,  cloves,  nutmeg,  etc. — is  perhaps 
one  of  the  best,  and  is  readily  made  fresh  as  required. 
It  can  also  be  mixed  with  milk,  meat-essence,  or 
beef-tea,  and  so  forms  a  useful  composite  food. 

Or  a  small  quantity  of  arrowroot,  ground-rice,  or 
well-baked  flour  can  be  added  to  clear  soup  or  to 
beef-tea.  Great  care  must,  however,  be  taken  that 
these  are  not  made  thick,  but  kept  quite  fluid.  Such 
food  is  easy  of  digestion  when  given,  sufficiently 
diluted,  in  very  small  quantities  at  a  time,  and,  by 
supplying  a  certain  amount  of  "  fuel  food,"  tends 
further  to  prevent  the  tissue-waste. 

Grape-sugar,  which  is  the  substance  that  results 
from  the  digestion  of  carbo  hydrates,  forming,  in  short, 
a  kind  of  predigested  carbo-hydrate,  has  been  strongly 
recommended  by  G.  See  and  other  writers  on  dietetics 
as  a  useful  food  in  fevers,  and  it  may,  therefore,  be 
added  with  advantage  to  farinaceous  foods,  and  used 
also  to  sweeten  beverages. 


3i6  Food  in  Disease.  [Partii.- 

Barley-  and  rice-water  are  given  more  as  bever- 
ages ;  but  they  also,  especially  if  sweetened  with  grape- 
sugar,  afford  a  certain  small  amount  of  carbo-hydrates. 

Tea  and  coffee  given  with  milk  and  grape-sugar, 
serving  both  as  food  and  beverage,  are  approved  of  by 
Bauer  and  See,  and  may  be  usefully  given,  from  time 
to  time,  to  vary  the  often  repulsive  monotony  of  the 
fever  diet.  We  consider  tea  and  coffee  too  little  used 
as  beverages  in  fever  cases. 

Bauer  also  commends  chocolate,  "  fine,  and  as  free 
as  possible  from  spices,  or  cacao  deprived  of  its  fat  and 
boiled  with  milk "  as  "  well  borne  by  most  sick 
persons." 

"Fruit-soups  "  are  commended  by  Bauer  as  "  agree- 
able and  useful  "  ;  they  are  "  made  by  boiling  fresh  or 
dried  fruits  with  water,  with  or  without  the  addition 
of  sugar,  lemon-peel,  etc.,  and  freed  from  the  solid 
residue  "  by  pressing  and  straining.  They  are  agree- 
able to  some  as  beverages,  and  they  contain  a 
minute  amount  of  albuminates,  somewhat  more  carbo- 
hydrates, and  some  organic  acids. 

The  unpleasant  taste  and  smell  of  peptonised  foods 
are  opposed  to  their  general  adoption,  unless  for  the 
purpose  of  rectal  alimentation.  If  this  objection  can 
be  overcome  by  the  addition  of  flavouring  agents,  as 
has  been  suggested,  then  they  are  useful  foods. 

We  now  come  to  the  question  of  beverages  in 
acute  febrile  diseases. 

In  the  first  place  a  fever  patient  should  be  allowed 
to  drink  freely  of  water  or  of  some  beverage  consisting 
almost  wholly  of  water  :  much  water  is  needed  not 
only  to  replace  the  loss  of  water  from  the  heated  body, 
constantly  passing  away  by  the  cutaneous  and  pul- 
monary surfaces,  but  also  to  provide  a  necessary 
solvent  medium  to  dissolve  and  carry  away  the  waste 
products  of  the  increa.sed  metabolism  of  the  tissues. 
Such  patients,  even  if  they  do  not  a.sk  for  drink,  should 
be  frequently  offered  it,  either  pure  spring  water,  or 
effervescing  water,  or  rice-  or  barley-water.  When 
the  temperature  is  high,  iced  water  should  be  oft<?n 


Chap.  I.]  Beverages  in  Fever.  317 

given.  Lemonade  is  highly  commended  by  Dujardin- 
Beaumetz,  who  calls  attention  to  the  testimony  of 
Maglien  *  to  the  decidedly  febrifuge  properties  of 
lemon  -decoction. 

Wine,  wine  and  water,  even  beer,  and  the  use  of 
alcohol  in  various  forms  are,  more  or  less,  commended 
in  the  dietetic  treatment  of  acute  diseases  by  most 
experienced  physicians  ;  our  own  opinion,  however,  is 
that  alcohol  is  not  absolutely  needed  in  the  majority  of 
cases  of  acute  disease,  viz.  those  cases  that  run  an 
even,  average  course,  without  urgent  or  alarming 
symptoms.  We  do  not  consider  that  alcohol  should 
be  given,  as  a  nvxtter  of  routine,  in  all  acute  diseases, 
and  in  all  stages  of  the  disease  ;  we  prefer  to  hold  it  in 
reserve  for  the  graver  cases,  or  for  the  terminal  stages 
of  the  average  cases  when  the  exhausting  effects  of  the 
febrile  process  become  especially  evident. 

The  use  of  alcohol  is  especially  indicated  in  the 
adynamic  forms  of  acute  disease,  in  old  age  and  also 
in  infancy.  Those  also  who  have  been  addicted  to  the 
habitual  use  of  alcoholic  drinks  have  more  need  of 
such  stimulants  when  they  are  attacked  with  acute 
disease  than  those  who  have  not  been  accustomed  to 
their  use. 

But  when  young  and  robust  persons  of  temperate 
habits  become  the  subjects  of  acute  febrile  disease, 
they  often  do  best  with  no,  or  with  very  little,  alcohol, 
at  any  rate  in  the  early  stages  of  the  malady. 
Dujardin  Beaumetz,  who  carefully  studied  the  ques- 
tion of  the  physiological  action  of  alcohol,  has  given 
the  following  concise  and  judicious  summary  of  the 
various  opinions  that  have  been  held  as  to  its  mode 
of  action  in  acute  disease,  together  with  his  own 
conclusions : — "  Some  see  in  alcohol  a  force-giving 
medicine  which  acts  in  febrile  disease  by  sustaining 
and  augmenting  the  strength  of  the  patient ;  others 

*  He  cuts  a  lemon,  as  fresh  as  possible,  into  small  pieces, 
without,  however,  separating  them  ;  he  adds  three  cups  of  water 
and  boils  down  to  a  cup,  strains  through  new  linen  and  expresses 
all  the  juice,  and  allows  it  to  cool  in  the  open  air. 


$iS  Food  in  Disease.  (Partii. 

regard  alcohol  as  an  antipyretic  which  lowers  tem- 
perature and  prevents  hyperpyrexia  ;  others  maintain 
that  alcohol  hinders  organic  disintegration,  while 
at  the  same  time  it  augments  the  amount  of  oxygen 
inspired  ;  while  others  assert  that  it  acts  simply  as 
a  food."  *  All  these  opinions  he  considered  true  in 
their  ensemble;  that  alcohol  acts,  at  the  same  time 
as  a  food,  as  a  tonic,  and  as  an  antipyretic,  and  it  is  this 
threefold  action  which  accounts  for  its  favourable 
effects  in  the  treatment  of  acute  febrile  maladies.  He 
maintains  that  "alcohol  is  a  food  and  undergoes  in 
the  organism  more  or  less  complete  combustion :  a 
combustion,  however,  which  takes  place  at  the  expense 
of  the  oxygen  of  the  blood,  and  in  that  way  it 
diminishes  the  pyrexial  phenomena  and  lowers  the 
temperature  ;  it  is  un  aliment  d'epargne  "  (i.e.  it  spares 
or  saves  the  combustion  of  the  tissues  by  offering  ilsel/ 
for  combustion  in  their  stead).  '•'  It  acts  also  on  the 
ner\'ous  centres  and  affords  them  strength  and  tonicity, 
and  is,  therefore,  a  force-giver." 

In  England,  when  alcohol  is  prescribed  in  acute 
diseases,  it  is  customarily  given  either  in  the 
form  of  a  strong  spirit,  such  as  brandy  or  whisky, 
diluted  with  water,  or  in  the  form  of  port  wine  or, 
occasionally,  in  the  form  of  champagne.  In  Con- 
tinental countries  the  lighter  wines  are  far  more 
commonly  employed.  "  In  the  General  Hospital  at 
Munich  150  to  300  grammes  [about  5  to  10  ounces] 
of  a  light  red  wine  are  generally  given  to  a  patient 
with  severe  fever,  or,  if  preferred,  the  like  quantity 
of  white  wine,"  f  and  in  the  hospitals  of  France  the 
ordinary  red  wines  of  Bordeaux  and  Burgundy  are 
used.  Bauer  recommends  that  the  strongly  alcoholic 
wines  and  concentrated  spirits  should  only  be  em- 
ployed when  it  seems  necessary  "  to  stimulate  the 
heart  to  energetic  action  and  to  obviate  a  tendency 
to  asthenia,"  and  he  points  out  that  "  restlessness  and 
irritability,  followed   by  a   degree  of  stupor,"  have 

*  "  Du  K^gime  Alimentaire  dans  les  Maladies  F^briles,"  p.  227. 

t  Bauer,  "Dietary  of  the  Sick,"  p.  232. 


ci^pi.]  ^i£T  IN  Convalescence.  319 

often  been  observed  to  follow  too  large  doses  of  stron<, 

1^l\^'?}''  ""^  ^'  ^^"«  attention  tnLfacf 
which  should  certainly  not  be  overlooked   that  th« 
contmued  use  of  alcohol,  in   a   concentra'ted  W 
injures  the  activity  of  the  organs  of  di^restion      wTh 

t£S^  ^'  ^  ^^""^"  ^"^^  ^-^^  he  eoTsider  t 
preferable  in  some  cases  to  wine.     "It  is  not"  C 

says,  "merely  a  stimulant,  but  also  contain    a  certaL 

amount  of  nourishment,"  and  is  much  less  costly  ttn 

^vlne.     In  many  cases  in  which  there  is  no  marked 

disturbance   of    digestion    it    may,    he   think?  "te 

allowed  without  hesitation."  ' 

It  must  be  borne  in  mind  that  the  li'.ht  German 
beer«  are  muc  1  more  suitable  for  this  purpose  tTan 
the  beers  usually  to  be  had  in  England 

Our  own  experience  has  led  us  to  re-ard  brandv 
or  whisky,  well  diluted,  as  the  best  form  of  a  co"S 

Woi  "r°'''  "^-^^^  ^^^"^^  stage,  and  thrt'or 
wine  or  champagne  is  more  useful  during  the  period 
of  convalescence;  or,  if  the  patient  prelvrs  a  lood 
Clare  or  Burgundy  at  this  timi,  there  is  no  ^b^ecln 
to  his  having  an  equivalent  quantity  of  these  wines 

'^i^^::^:''^  "^^^  ^^-'^^  -^^^ 

During  coiivalescciicc  from  acute  febrile  mala 

tliX'T^  still  needed  in  the  superSion  of 

from  tvuhoi  ri'  ""^^""f^  '^''  '""'^  ^"  convalescence 
n?.^  1^^  ""'"^   ^.^''^''l   '^'^^^   S'-eat  firmness   is  often 

a  more  hwT'^"?  *'^  P^'^"^^'^  -«-^  entreatieff" 
a  more  liberal  and  more  varied  diet.  The  appetite  i, 
often  voracious,  and  the  craving  for  food  £  the 
prolonged  period  of  inanition  he^.as  passed  tl^ouJt 

t)erecl  that  the  digestive  powers  are  still  very  limited 
and  that  any  solid  food  that  escapes  digestfon  in  ufe 
stomach  may  act  as  an  irritant  in  passing  alon"  t le 
mtest.nes,  still  the  seat  of  slowly-healing  ulcerate 
and  inflammatory  changes.  *  ulcerative 

It  has  been,  again  °md  again,  observed  that  th« 
smallest  indulgence  in  solid  food  during  the  fir't  ft      ' 


320  Food  in  Disease.  [Panii. 

days  of  convalescence  from  typlioid  is  frequently 
followed  by  a  rise  of  temperature  and  sometimes  by  a 
serious  relapse. 

It  is  needful,  therefore,  that  for  the  first  week  or 
ten  days  of  convalescence  a  fluid  dietary  should  still 
be  maintained :  a  little  well-soaked  bread-crumb, 
rubbed  through  a  fine  sieve,  may  be  added  to  clear 
soups  or  beef-tea,  or  these  may  be  slightly  thickened 
with  ground  rice  or  well-baked  flour.  The  digestion 
of  the  patient  must,  however,  be  carefully  watched 
for  any  symptoms  of  dyspepsia.  More  consistent 
farinaceous  foods — rice-milk,  sago,  tapioca,  arrowroot 
— may  next  be  given  in  small  quantities  at  a  time, 
and  small  quantities  of  pounded  meat  may  be  mixed 
with  clear  soup  or  light  broth.  Custard  puddings 
with  fruit  jelly  are  nutritious,  and  generally  prove 
an  agreeable  change.  Pounded  raw  meat  is  largely 
given  by  French  physicians  in  convalescence  from 
acute  maladies,  and  is  regarded  by  many  as  a  most 
valuable  restorative  food.  It  is  said  by  Fick  to  be 
three  times  as  rapidly  digested  as  cooked  meat. 

Robin,  in  his  well-known  work  on  the  treatment 
of  the  complications  and  the  convalescence  of  typhoid 
fever,  gives  the  following  regime,  which  English 
physicians  will  certainly  regard  as  erring  on  the  side 
of  liberality  : — "  As  soon  as  the  morning  and  evening 
temperature  have  fallen  below^  100°  F.,  give  twice  a 
day  a  soup  with  tapioca  or  semolina,  or  some  panada. 
At  the  end  of  two  days,  if  the  urine  is  free  fiom 
albumen  and  excess  of  urea,  add  an  egg  to  the  .soup, 
and  give  a  little  meat  jelly,  but  no  bread.  The 
fourth  day  increase  the  quantity  of  jelly  or  give  some 
meat  juice  (essence  of  meat),  and  in  addition  three  to 
six  small  oysters  and  a  few  well-cooked  prunes  (!)  at 
dessert.  The  fifth  day  order  some  light  fish,  such  as 
whiting  and  the  pulp  of  a  cooked  apple.  From  the 
sixth  to  the  eighth  day  you  may  permit  a  cutlet." 
Bordeaux  or  Burgundy  is  to  be  taken  at  meals,  mixed 
with  effervescing  water,  and  milk  may  be  drunk 
between  meals. 


Chap.  I.]       Feeding  in  Enteric  Fever.  321 

The  intestinal  lesions  that  occur  in  cases  of  enteric 
fever,  and  the  tendency  to  severe  diarrlicea  and  hse- 
morihage  connected  therewith,  call  for  a  few  more 
observations  on  the  dietetic  management  of  cases  of 
that  disease.  The  now  generally  recognised  necessity 
of  maintaining,  so  far  as  is  possible,  intestinal  anti- 
sepsis in  this  disease  also  calls  for  a  clear  examination 
of  our  dietetic  rules,  for  in  order  to  pi'omote  in- 
testinal antisepsis  it  is  needful  to  see  that  as  little 
unabsorbed  food  as  possible  is  allowed  to  accumulate 
in  the  small  intestine,  and  there  to  undergo  irritative 
decomposition. 

We  have  pointed  out  elsewhere*  that  we  must 
"  adopt  a  method  of  feeding  which  can  by  no  possi- 
bility leave  a  bulky  residue  of  unabsorbed  material  to 
undergo  putrefactive  changes  in  the  lower  part  of  the 
small  intestine,  and  by  its  presence  there  excite 
and  maintain  diarrho?a,  and  probably  an  extension  of 
the  ulcei-ative  and  inflammatory  changes  dependent 
on  bacillary  infection  of  the  intestinal  glands.  For 
this  purpose  we  must  note  carefully  what  digestive 
and  absorptive  capacity  exists  in  each  individual  case. 
In  many  this  will  be  found  to  be  extremely  small. 
Let  this  be  well  noted,  for  the  neglect  to  do  so  is 
responsible  for  much  avoidable  mischief.  Tlie  fault 
usually  lies  in  the  too  free  administration  of  milk. 
We  have  again  and  again  seen  milk  break  down 
utterly  as  a  food  for  typhoid  patients.  In  some  cases 
we  have  seen  it  vomited  as  a  firm  cheesy  mass  soon 
after  it  has  been  taken  into  the  stomach,  and  in 
many  others  we  have  noted  the  maintenance  of 
diarrhoea  to  be  dependent  upon  the  irritation  of 
masses  of  milk  curd  passing  through  the  inflamed 
and  catarrhal  intestine.  These  are  obvious  instances 
of  the  failure  of  milk  as  a  food.  There  are  others  far 
more  common  in  which  it  will  be  foumi,  if  the  alvine 
dejections  are  carefully  examined  and  estimated,  that 

*  "  The  Management  of  Fever,  and  particularly  of  Typhoid  or 
Enteric  Fever." — American  Journal  of  the  Medical  Sciences, 
June,  1894. 


32a  Food  in  Disease.  [Panii. 

nearly,  if  not  quite,  all  the  casein  of  the  milk  taken 
as  food  is  passed  undigested,  not  aa  coarse  cuds,  but 
as  a  fine  deposit  from  the  so-called  '  pea-soup '  stools. 
We  have  again  and  again  proved  this,  and  shown  that 
the  amount  of  milk  absorbed  is  in  many  cases 
remarkably  small,  and  to  persist  in  giving  food  that 
is  not  absorbed  is  to  persist  in  introducing  decom- 
posable material  into  the  intestine  when  we  wish  to 
keep  it  free  from  putrefactive  decomposition,  and 
to  maintain  diarrhoea  when  we  wish  to  keep  the 
bowels  at  rest.  It  is  the  popular  mania  for  feeding 
which  induces  us  to  give  food  when  it  simply  passes 
as  an  irritating  decomposing  substance  along  the 
intestinal  tube.  Remember  that  it  is  useless  and 
injurious  to  give  in  these  cases  food  that  cannot 
be  absorbed.  We  should  endeavour  to  estimate 
accurately  the  absorptive  capacity  of  the  patient. 
If  he  cannot  absorb  mUk  at  all,  give  him  some  other 
food.  If  he  cannot  absorb  four  pints  in  the  24  hours, 
give  him  two,  and  if  he  cannot  absorb  two  pints,  give 
him  one.  Give  all  food  very  dilute.  Milk  is  best 
diluted  with  twice  its  bulk  of  water,  and  in  the 
manner  previously  described.  We  wish,  for  antiseptic 
and  eliminative  reasons,  to  give  as  much  pure  water 
as  the  patient  will  drink — give  some  of  it,  then,  as 
a  diluent  of  his  food.  When  milk,  however  small 
in  quantity,  absolutely  disagrees,  very  dilute,  freshly- 
made  clear  soup,  in  the  making  of  which  .some 
aromatic  herbs  and  fresh  vegetables  have  been  used, 
is  the  best  substitute.  Dilute  albumen-water,  made 
with  the  white  of  egg,  is  also  then  serviceable.  .  .  . 
The  antiseptic  principle  applied  to  the  feeding  of 
typhoid  patients  necessitates,  then,  the  administration 
of  food  in  a  dilute  liquid  form — food  that  remains 
liquid  in  the  body  as  well  as  outside  it,  which  is  not 
prone  to  be  suddenly  rendered  solid  by  chemical 
change  as  undiluted  and  unprepared  milk  is.  We  do 
not  suggest  that  milk  should  not  be  used  in  a  diluted 
form  whenever  it  is  fonnd  to  be  well  tolerated  and 
freely  absorbed,  but  we  would  urge  the  necessity  of 


Chap.  I.]       Feeding  in  Enteric  Fever.  323 

exchanging  it  for  other  foofl  when  it  is  seen  that 
much  solid  thougli  finely  reduced  casein  is  passing 
in  the  motions." 

In  a  very  severe  case  of  typhoid  we  had  recently 
under  our  care  in  King's  College  Hospital  with  most 
alarming  and  unusually  profuse  haemorrhage— 40  oz. 
of  blood  being  discharged  from  the  bowels  on  the  first 
occasion,  and  smaller  hfemorrhages  continuing  to  occur 
for  three  or  four  days — we  carried  out  a  rigorous 
method  of  feeding,  with  remarkably  satisfactory 
results.  The  clear  indication  was  to  keep  the  intes- 
tines absolutely  at  rest,  and  to  allow  no  debris  of  food 
to  pass  througJi  to  excite  peristaltic  action.  Tt  was 
necessary,  therefore,  to  give  a  food  which,  while 
adequate  to  sustain  the  strength  of  the  patient, 
should  be  wliolly  absorbed  in  the  stomach  and  upper 
part  of  the  small  intestine.  To  give  milk  might  be 
fatal.  For  our  purpose  we  selected  Valentin's  meat 
juice,  giving  only  one  teaspoonful  in  a  wineglassful  of 
cold  water  every  three  liours,  with  one  teaspoonful  of 
brandy.  The  patient's  diet  was  absolutely  limited  to 
these  quantities  for  seven  days — i.e.  so  long  as  any 
sign  of  hiemorrhage  was  observed,  for  clots  continued 
to  come  away  during  nearly  this  space  of  time.  This 
food,  we  were  sure,  would  deposit  no  solid  residue. 

The  plan  answered  admirably,  and  the  patient 
made  a  perfect  recovery,  and  a  fairly  rapid  con- 
valescence, regaining  her  flesh  and  strength  quite  as 
quickly,  if  not  more  so,  than  cases  do  that  have  been 
liberally  fed.  This  is  a  striking  instance  of  how  little 
food  or  stimulant  is  needed,  under  certain  cii'cuni- 
stances,  even  in  some  of  the  most  severe  forms  of 
typhoid. 

We  may  here  mention  that  we  have  found  an 
infusion  of  coffee  to  be  an  excellent  stimulating 
beverage  in  protracted  cases  of  typhoid  with  much 
cardiac  debility.  It  may  be  combined  with  alcohol, 
and  we  have  found,  with  this  mixture,  more  marked 
and  sustained  stimulation  of  the  heart  than  when 
alcohol  alone  has  been  given.  We  have  too  much 
y2 


324  Food  in  Disease.  iPan  ii 

neglected  those  excellent  cardiac  stimulants  —  tea 
and  coffee — in  the  treatment  of  fevers.  We  must 
always,  however,  note  their  effect  on  the  diarrhoea 
if  this  symptom  is  present,  as  with  some  patients 
these  fluids  seem  to  aggravate  this  tendency. 

Dr.  Springthorpe,  of  the  Melbourne  Hospital,  has 
suggested  and  largely  tested  clinically  a  new  food  to 
take  the  place  of  milk  in  typhoid  and  other  fevers. 
It  is  a  "  sterilised  hopped  malt  extract " — indeed,  a 
kind  of  beer.  He  has  found  that  it  answers  extremely 
well,  and  that  patients  do  better  on  this  food  than  on 
milk.  The  following  is  the  method  he  describes  for 
its  preparation  : — "  Infuse  crushed  English  barley 
malt  with  twice  its  weight  of  water  at  165°  for  two 
hours.  The  mash  produced  should  be  at  151°.  After 
draining,  the  sweet  wort  is  run  out,  and  '  sparged  ' 
with  water  at  170°  until  the  malt  is  perfect W 
extracted.  It  is  then  collected  in  the  copper,  and 
when  saccharification  is  comi)lete  saccharose  sugar  is 
added  to  bring  about  inversion  into  dextrose  and 
Ijevulose  by  the  diastase  of  the  malt.  Tiie  contents  of 
the  copper  are  now  brought  to  the  boiling-point,  and 
after  boiling  for  half  an  hour  to  precipitate  the 
albuminoids  thus  removable,  hoj)S  are  added,  and  the 
boiling  continued  for  one  and  a-half  hour.  The 
tannin  of  the  hops  precipitates  a  further  portion  of 
the  crude  albuminoids.  This  wort  is  then  run  over  a 
large  quantity  of  raw  hops  to  extract  therefrom  an 
additional  quantity  of  the  essential  oil  and  other 
volatile  constituents  of  the  lupulin.  In  all,  twelve 
pounds  of  hops  and  one  and  a-half  cwt.  of  sugar  are 
used  to  each  quarter  of  malt.  The  extract  is  then 
bottled,  corked,  and  put  into  a  steam  bath  at  212°, 
and  kept  at  that  temperature  for  two  hours.  As 
soon  as  the  bottles  are  lukewarm  after  removal  they 
are  laid  on  their  sides.  If  this  had  been  done  before, 
the  vacuum  formed  during  cooling  would  have  given 
rise  to  an  explosion.  If  good  corks  are  used,  the 
filtration  through  them  is  sufficient  to  sterilise  the 
entrant  air,  and  if  left  on  their  .sides  contamination 


Chap.  I.]       Feeding  in  Enteric  Fever.  325 

does  not  occur.  The  bottles  are  now  ready  for  use. 
On  keeping,  a  further  precipitate  is  produced  by  the 
oxidation  of  the  albuminoids,  but  this  can  be  easily 
separated,  if  desired,  by  filtering  the  last  portion  be- 
fore use.  The  composition  of  the  hops  is — hop  oil,  0  ; 
lupulin,  11  ;  tannin,  ^  to  2  ;  gum,  5  to  6  ;  and  cellulose, 
63  to  70.  Assuming  that  only  one-half  the  principle 
is  extracted,  there  are  eight  and  a-half  grains  of 
lupulin  in  three  pints  of  the  extract."* 

*  Amtralian  Medical  Jom-nal  for  July  20th,  1894. 


326 


CHAPTER   II. 

THE  DIETETIC  TREATMENT  OP  DISEASES  OF  THE  DIGES- 
TIVE ORGANS— ACUTE  AND  CHRONIC  GASTRIC 
CATARRH — ^GASTRIC    ULCER — CANCER    OF    STOMACH 

— DILATATION     OP     THE      STOMACH DYSPEPSIA  — 

CONSTIPATION — DIARRHCEA. 

Diseases  or  disoi'ders  of  those  organs  which  are 
actually  concerned  in  the  digestion  and  assimilation 
of  food  must  necessarily  and  especially  be  greatly 
under  the  influence  of  appropriate  dietetic  treatment. 
The  subject,  however,  of  the  dietetic  treatment  of 
diseases  of  the  organs  of  digestion  is  a  complicated 
and  difficult  one,  as  it  involves  some  obscure  and 
disputed  points  in  connection  with  the  physiology  of 
digestion,  and  as  it  is  associated  with  many  contro- 
versial questions  in  which  the  general  public  take  a 
prominent  interest. 

It  will  be  our  object  here  to  avoid,  so  far  as 
possible,  the  introduction  of  matters  which  are 
especially  open  to  dispute,  and  to  strive  to  make  our 
teaching  as  simple  and  practical  as  possible,  and  in 
haiinony  with  the  ripe  experience  of  com]jetent,  care- 
ful, and  unbiassed  observers. 

It  is  most  important  also  to  keep  in  view  the  fact 
that  we  are  now  dealing  with  questions  which  are 
remarkably  subject  to  individual  peculiarities,  and 
that  the  widest  divergences  of  opinion  may  often  be 
found  to  rest  on  the  apparently  indisputable  basis  of 
personal  experience.  So  that  after  framing  general 
dietetic  rules,  we  must  be  prepared  to  exercise  much 
discrimination  in  their  mode  of  application  ;  for  food 
that  is  readily  digested  by  one  person  will  often  prove 
hurtfid  to  another ;  and  even  in  the  same  person 
food  which  is  found  beneficial  at  one  time  Avill  at 
another  time  cause  acute  digestive  derangement. 


Chap.  II.]  Diseases  of  the  Digestive  Organs.   327 

Those  instances  of  retarded  or  disturbed  digestion 
which  obviously  arise  from  indulgence  in  an  excessive 
quantity  of  food  generally,  or  from  excess  in  the  con- 
sumption of  some  particular  food,  or  food-accessory, 
suggest  the  equally  obvious  remedy  of  moderation  or 
abstinence ;  while  faulty  habits  of  feeding,  such  as 
hasty  and  incomplete  mastication  and  insalivation,  or 
insufficient  rest  from  other  occupation  before,  during 
and  after  meals,  indicate  their  own  remedy. 

It  will  only  be  necessary,  in  tlie  case  of  reasonable 
persons,  to  point  out  to  them  that  the  function  upon 
the  due  and  healthful  performance  of  which  the  per- 
fection of  all  the  other  physical  and  mental  activities 
depends,  deserves  and  should  receive  a  proper  amount 
of  time  and  attentiou. 

It  has  often  been  urged  on  those  busy  and  ener- 
getic persons  who  ap|)ear  to  grudge  every  moment 
taken  from  their  intellectual  or  mechanical  labours, 
that  when  the  stomach  is  called  into  activity  by  the 
presence  of  food,  an  increased  supply  of  blood  is 
needed  by  that  organ  to  meet  the  increased  demands 
on  its  functions,  and  in  order  to  secure  and  maintain 
that  needed  supply  the  blood  should  not  at  that 
period  be  diverted  strongly  to  other  organs,  which 
will  be  the  case  if  they  are  then  called  into  activity. 

Another  difficulty  encountered  in  the  considera- 
tion of  this  subject  is  one  of  classification.  The  word 
"dyspepsia"  or  "indigestion,"  so  commonly  applied 
to  stomach  disorders,  is  one  of  somewhat  vague  and 
indeterminate  meaning,  and  is  undoubtedly  often 
employed  to  designate  morbid  conditions  which  differ 
considerably  in  their  nature  and  origin — from  states 
of  slight  temporary  gastric  disturbance,  to  those 
grave  disoi'ders  which  are  connected  with  the 
existence  of  chronic  structural  disease. 

Many  dyspeptic  states  are,  however,  associated 
with  quite  definite  morbid  conditions  of  the  stomach, 
and  it  will  conduce  to  clearness  of  exposition  if  we 
treat  of  these  first  of  all,  and  reserve  the  less  well- 
defined  forms  of  dyspepsia  for  subsequent  examination. 


328  Food  in  Disease.  (Pan  11. 

Acute  gastritis  or  acute  (jastric  catarrh  and  chronic 
gastritis,  or  chronic  gastric  catarrh,  are  more  or  less 
well-de fined  maladies ;  so  are  cases  of  tdcer  of  the 
stomach  and  cancer  of  the  stomach.  We  propose, 
therefore,  to  consider  the  dietetic  ti'eatment  of  these 
affections  first,  and  afterwards  to  pass  on  to  the  con- 
sideration of  those  dyspeptic  states  which  may  be 
referred  either  to  irritation  of  the  sensory  nerves  of 
the  mucous  membrane,  or  to  some  defect  in  the 
secretion  of  the  digestive  juices,  or  to  some  impair- 
ment or  alteration  of  the  muscular  movements  of  the 
alimentary  canal,  or  to  other  less  obvious  causes. 

Acute  g:astric  catarrli  is  a  common  disease, 
and  is  caused  usually  by  the  action  of  improper  and 
irritating  food  on  the  gastric  mucous  membrane.  Any 
local  irritant  may,  of  course,  excite  inflamuiation  of 
this  membrane  if  brought  in  contact  with  it,  and 
acute  gastiic  catarih  is  an  abiiost  invariable  accom- 
paniment of  irritant  poisoning ;  but  the  common  and 
familiar  forms  of  this  disease  are  most  frequently  the 
result  of  improper  feeding.  Some  persons  are,  how- 
ever, much  more  predisposed  to  suffer  from  this 
disease,  from  comparative  slight  causes,  than  others. 

It  has  been  pointed  out  that  too  scanty  a  secretion 
of  gastric  juice,  by  letarding  digestion  and  favouring 
abnormal  decomposition  of  food  within  the  stomach, 
predisposes  to  this  malady,  and  hence  it  is  necessary 
in  febrile  states  when,  owing  to  the  high  temperature, 
there  is  nmch  loss  of  fluid  from  the  skin  and  lungs, 
uxid  from  this  and  other  reasons  a  greatly  diminished 
secretion  of  gastric  juice,  to  diminish,  accordingly,  the 
quantity  of  food.  The  common  custom  of  urging 
such  patients  to  take  more  nourishment  than  they 
wish  is  often  injurious,  unwise,  and  unphysiological. 

Anaemic  and  feeble  persons  generally,  and  con- 
valescents from  acute  disease,  are  also  liable  to  attacks 
of  acute  gastric  catarrh  from  taking  more  food  than 
the  small  amount,  or  the  altered  and  Jess  active 
character,  of  their  gastric  juice  is  capable  of  dealing 
with,     so    that     some    of    the    undissolved    ingesta 


Chap.  II.]         Acute  Gastric  Catarrh.  329 

decompose  and  set  up  irritation  of  the  gastric 
inucou.s  membrane. 

It  is  indeed  most  important  to  bear  in  mind  that 
the  over-anxiety  manifested  by  the  friends  of  such 
patients  that  they  should  take  large  quantities  of 
food,  in  order  quickly  to  recover  their  strength,  lias 
often  the  opposite  effect  to  the  one  desired. 

Overloading  the  stomach  with  food,  even  in  healthy 
persons,  is  a  common  cause  of  acute  gastric  catarrh, 
owing  to  the  abnormal  decompositions  which  the 
excess  of  ingesta  undergoes.  This  is  a  frequent 
cause  of  gastric  catarrh  in  young  children,  and 
especially  in  children  at  the  breast  who  are  allowed, 
for  the  sake  of  quiet,  to  suck  until  they  overload 
their  stomachs. 

Imperfect  mastication  also  may  give  rise  to  gastric 
catarrh,  as  the  food  then  reaches  the  stomach  in  a 
comparatively  undivided  state,  so  that  the  gastric 
juice  comes  into  very  imperfect  contact  with  it,  and 
hence  portions  remain  undissolved  and  undergo  de- 
composition. Kich  and  fat  sauces,  and  too  much 
fat  eaten  witli  mest,  may  lead  to  the  same  result, 
by  covering  or  soaking  the  meat  with  an  oily  fluid 
which  prevents  the  gastric  juice  from  thoroughly 
penetrating  it. 

Food  eaten  when  it  is  already  in  a  state  of  de- 
composition may  similarly  give  rise  to  gastric  catarrh  ; 
and  this  is  especially  noticeable  in  delicate  and  sen- 
sitive persons.  Game  or  fish  kept  too  long,  entries 
made  Avith  meats  that  are  not  perfectly  fresh,  new 
beer  and  sour  wine,  and  in  young  children  milk 
that  is  not  quite  fresh,  or  that  has  become  con- 
taminated by  micro-organisms,  are  fruitful  sources 
of  .gastric  cp.tarrh. 

Too  free  use  of  spices  and  stimulating  condiments, 
but  especially  the  habit  of  taking  alcohol  in  a  con- 
centrated form,  lead  to  the  .same  result. 

In  severe,  cases  of  acute  gastric  catarrh,  the  in- 
dication with  respect  to  food  is  so  to  limit  it  in 
quantity  and  quality  that  the  acutely  inflamed  mucous 


33°  Food  in  Disease.  iPsutii. 

membrane  shall  be  spared  all  irritation  or  excitement 
from  ingesta,  and  the  wliole  organ  be,  so  far  as  is 
possible,  put  in  a  condition  of  physiological  rest. 
Entire  abstinence  from  food,  at  least  from  food  by 
the  mouth,  may  often  be  enforced  with  advantage 
for  a  day  or  two,  or  so  long  as  the  taking  of  food 
excites  nausea,  or  vomiting,  or  severe  pain.  This 
abstinence  is  usually  well  borne,  except  in  cases 
where  the  strength  has  been  exliausted  by  previous 
suffering,  and  long  inability  to  digest  a  sufficient 
quantity  of  food  ;  in  such  cases  nutrient  enemata 
may  for  a  time  be  given,  so  as  to  secure  the  rest 
needed  by  the  hypersemic  and  irritated  gastric  mucous 
membi'ane ;  while  small  quantities  of  iced  water  may, 
from  time  to  time,  be  taken  into  the  stomach. 

When,  however,  there  is  a  great  craving  as  well 
as  a  real  need  for  food,  fluid  nourishment  only  must 
be  carefully  administered.  In  the  selection  of  such 
fluid  foods  it  must  be  remembered  that  the  gastric 
secretion  is  alkaline,  from  admixture  with  mucus ; 
that  its  digestive  power  is,  therefore,  greatly  impaired, 
and  that  there  is  a  great  tendency  to  abnormal  de- 
composition of  food  in  the  stomach.  Milk,  if  given 
undiluted,  or  eggs,  or  any  food  requiring  acid  gastric 
juice  for  digestion,  may  be  found  to  disagree.  In 
such  cases  we  should  dilute  the  milk  with  an  equal 
quantity  of  soda-,  or  lime-water,  and  in  some  instances 
admixture  with  the  stronger  alkaline  waters,  such  as 
Vichy  or  Vals,  is  preferable,  as  it  seems  to  check 
the  tendency  to  curdling  of  the  milk,  and  the  forma- 
tion of  an  irritating  coagulum  in  the  stomach.  In 
some  instances,  where  there  is  an  obvious  inability 
to  digest  the  casein  of  milk,  whey,  freshly  prepared, 
should  be  substituted  for  milk,  and  its  nutritive 
qualities  may  be  increased  either  by  the  addition  of 
a  little  beef-essence,  or  by  shaking  up  the  yolk  of 
an  egg  with  a  little  hot  water  and  adding  this  in 
suitable  proportion  to  the  whey. 

It  is  most  important  that  all  food  used  in  these 
cases  should  be  quite  fresh  and  freshly  prepared. 


in  a  vessel  of  boiling  JtZ      rt-  T"'''^  ^""^ 

infante,  wl,o  cannot  f,t.-ii  ""^  '*  8'™"  »<> 

andinWger;„7„°iti?st::il'°„'rEa't'°^'''' 
"'™^r  (page  263)  may  be  u^  in.tL  '""'  '''"" 

food^t  bTstTSe'if r'^  to  non-coagulable  liquid 

permit  large  dl^tsVcordM^^  '"'"''''  *'■»  '^ 
«ll.eri„g"to\°'fl„id%'n'  ''™'-°  "»^^^'   "i-ife  «"" 

pa.«i.  be:;^^a;  chL^eroYi^r^^^s^  r '""^  p'^- 
^r;^:i"/;eVa7S'' ^trv«^^ 

r '.i:sn:-a':,«r  r-^^^^^ 

brandy  are  tl,e  best  to  te  Xen   ''t?'"""^''^  ?<""' 
to  beef-tea  armwnof  „  "*  «'>«n-     It  may  be  added 

withsoda;aLr      All  w  '"V*'™"  """  <'''°'e'' 

''ionally,  Wever  „  iT  T  ^^  "'"''^'^ '  ^""^■ 
soda-water  agrees'  '  11  w?l  "'"'"?■''«».<'  ">i='ed  with 
cases  a  little  Ilk  ^  aj  *  °  f  i"""*"^ '  '"  °"""- 
stiamlant,  rel'rbe^ngl  "  ^ Z'^J"A''''T'""^ 
good  quality.  *"        ^    ""  "'^  *^''«'a  tea  of 

-'"-^'f- -t\sx'id"di^Sd^x;: 

That  prepared  by  Savory  and  Moore. 


332  Food  in  Disease.  [Partii. 

the  smallest  quantity  of  unprepared  milk  would  at 
once  excite  vomiting. 

Upon  the  disappearance  of  nausea,  vomiting  and 
pain  after  food,  and  with  the  return  of  appetite  and 
digestive  power,  a  small  quantity  of  solid  food  may  be 
cautiously  added  to  the  diet,  which  should,  however, 
still  consist  mainly  of  lluid  food,  and  the  return  to  the 
ordinary  diet  should  be  very  gradual,  and  carefully 
watched.  It  is  best  at  first  to  add  a  little  pounded 
beef  or  chicken  to  thin  broths  or  clear  soups,  or  to 
beat  up  the  yolk  of  an  egg  with  milk,  or  to  add  the 
yolk  of  an  egg  to  a  cup  of  Avarm  consommi.  Fragments 
of  stale  bread  or  toast  may  be  soaked  in  hot  milk,  or 
may  he  added  to  broth  or  beef -tea  ;  but  above  all  we 
should  be  careful  to  discard  at  once  any  article  of  food 
which  is  observed  to  re-excite  any  uneasiness. 

On  recovery,  care  should  be  had  to  avoid  any  of 
the  exciting  causes  of  gastric  catarrh  which  we  have 
mentioned,  and  only  the  lighter  and  more  readily 
digested  foods  should  be  taken,  and  those  sparingly, 
and  at  sufticiently  long  intervals  to  allow  of  their 
complete  digestion.  Boiled  chicken,  or  pheasant,  the 
lean  of  boiled  neck  of  mutton,  well  selected,  the  under- 
cut of  the  sirloin  of  beef,  free  from  fat,  boiled  or 
soused  sole,  or  whiting,  or  Hounders;  or,  if  grilled,  they 
should  be  takeu  without  butter  or  sauce,  simply  with 
a  little  salt  and  pepper  or  lemon -juice. 

Clii-oiiic  g;asti'ic  catai-iii  is  sometimes  a  sequel 
of  the  acute  affection,  and  it  may  be  caused  by  the 
same  dietetic  errors  which  we  have  already  referred  to 
as  favouring  the  development  of  the  acute  disease. 
But,  probably,  the  most  frequent  cause  of  chronic 
gastric  catarrh  is  the  abuse  of  alcoholic  beverages,  and 
especially  the  habit  of  drinking  ardent  or  but  slightly 
diluted  spirits.  Chronic  gastric  catarrh  is  also  an  almost 
inevitable  accompaniment  of  any  disease  which  leads 
to  portal  obstruction  and  consequent  congestion  of  the 
gastric  mucous  membrane ;  it  is,  therefore,  common 
to  find  gastric  catarrh  existing  as  a  comjilicatiou  of 


Chap.  II.]        Chronic  Gastric  Catarrh.  333 

hepatic  disease,  and  of  tliose  diseases  of  the  heart  and 
lungs  which  cause  obstiuction  in  the  inferior  vena 
cava,  and  so  hinder  the  outflow  of  blood  from  the 
liver  and  stomach. 

It  often  accompanies  pulmonary  consumption,  and 
it  is  always  present  in  chronic  organic  disease  of  the 
stomach  itsejf.  It  is  important  to  bear  in  mind  that 
in  chronic  gastric  catarrli  the  mucous  membrane  of 
the  stomach  is  commonly  covered  with  a  layer  of 
greyish  white,  tough,  strongly  adherent  mucus. 

The  chief  symptoms  of  this  disease  are  those  which 
are  usually  described  as  .symptoms  of  indigestion  or  chjfi- 
pepsia — viz.  a  sense  of  fulness,  uneasiness,  and  flatulent 
distension  of  the  stomach  after  taking  food.  Gases  are 
formed  by  abnormal  fermentation  and  decomposition 
of  the  food,  which  is  unduly  delayed  in  the  stomach, 
and  the.se  distend  that  organ,  and  are  often  eructated 
into  the  mouth  together  with  fragments  of  undigested 
food  and  rancid  sour  fluids.  Lactic  and  butyric  acids 
are  generated,  chiefly  from  morbid  transformation  of 
starchy  foods,  and  these  ticrid  and  sour  fluids,  when 
eructated,  give  rise  to  the  uncomfortable  hot  feeling 
described  a.s  heartburn.  In  alcoholic  cases  there  is 
often,  especially  in  the  morning,  vomiting  of  stringy 
tenacious  mucus,  or  of  a  quantity  of  insipid  fluid, 
or  of  a  fluid  which  is  sometimes  described  as  "  oily." 
This  symptom  is  sometimes  spoken  of  as  "  water- 
brash."  Much  of  this  vomited  fluid  is  considered  to 
be  composed  of  saliva  swallowed  during  the  night. 
The  appetite  is  usually  greatly  diminished,  or  wholly 
lost ;  but  sometimes  there  is  an  eagerness  for  food, 
which,  however,  is  very  soon  satisfied.  Constipation 
is  a  common  accompaniment  of  this  malady,  and  so  is 
a  condition  of  mental  depression. 

The  dietetic  treatment  of  these  cases  should  be 
strict  and  systematic.  In  some  instances,  and  es- 
pecially in  those  which  follow  an  acute  attack,  an  ex- 
clusively milk  diet  often  answers  well,  and  will,  within 
a  moderate  period,  effect  a  cure.  But  it  is  always 
necessary  to  have  regard  to  individual  peculiarities  in 


334  Food  in  Disease.  [Pan  ii. 

the  digestion  of  milk,  and  not  to  insist  upon  this  diet 
in  persons  who  obviously  suffer  discomfort  after  taking 
it.  Before  giving  it  up,  however,  it  may  be  advisable 
to  endeavour  to  promote  its  digestion  and  assimilation 
by  various  means.  The  milk  may  be  skimmed  and 
much  of  its  fat  removed,  if  that  should  be  the  difficulty; 
or  it  maybe  boiled  or  diluted  with  hot  water;  or  what 
often  proves  of  great  service  in  promoting  its  digestion 
is  the  addition  to  it  of  some  effervescent  alkaline 
water,  or  one  of  the  alkaline  carbonates  :  one-third 
of  Vichy  water  and  two- thirds  milk  is  a  good  mixture; 
or  equal  parts  of  milk  and  Apollinaris*;  or  a  powder 
consisting  of  10  grains  of  bicarbonate  of  soda,  5  grains 
of  light  magnesia,  and  10  grains  of  common  salt, 
added  to  every  tumblerful  of  milk,  or,  better,  two- 
thirds  milk  and  one-third  hot  water,  will  often  secure 
its  easy  digestion.  The  object,  of  course,  is  not  to 
allow  a  compact  coagulum  of  casein  to  be  formed  in 
the  stomach.  Peptonised  milk,  as  we  have  already 
mentioned,  often  agrees  well.  In  difficult  chronic 
cases  only  small  quantities  should  be  taken  at  a  time, 
about  six  ounces  every  three  hours,  and  it  should  be 
drunk  slowly.  In  the  gastric  catarrh  of  alcoholism, 
when  accompanied  with  great  thirst,  we  have  seen 
excellent  results,  in  some  persons,  from  a  diet 
composed  chiefly  of  a  mixture  of  equal  parts  of 
milk  and  Apollinaris  water,  and  this  has  been  taken 
in  considerable  quantities  without  the  least  diffi- 
culty, provided  the  tendency  to  constipation,  which 
commoidy  accompanies  a  milk  diet,  be  corrected 
by  a  dose  of  Carlsbad  salts  every  morning  fasting. 
Such  a  dose  has  the  advantage  of  unloading  the  often 
engorged  portal  vessels,  and  so  tending  to  lessen  the 
gastric  hypersemia.  Many  German  phy.sicians  have 
found  huUer-milk  suit  souie  patients  better  than  fresh 
milk,  and  we  have  ourselves  observed  the  same  in 
certain  instances  of  chronic  gastric  catarrh. 

Nieraeyer  quotes  with  approval  the  prescription  : 

*  If  this  mixture  be  made  in  a  stoppered  decanter   it  will 
pour  out  fresh  and  effervescent  for  some  time. 


Chap.  II.]        Chronic  Gastric  Catarrh.  335 

"  When  the  patient  is  hungry,  let  him  eat  butter-milk; 
when  he  is  thirsty,  let  him  drink  butter  milk  ";  and 
he  suggests,  as  an  explanation  of  the  brilliant  results 
that  sometimes  follow  its  adoption,  that  fresh  milk  is 
perhaps  "  not  so  well  borne,  because  it  readily  curdles 
in  the  stomach,  and  forms  large,  firm  lumps,  while  in 
the  butter-milk  the  casein  is  already  curdled,  but 
finely  divided." 

Surgeon-Major  Goldsmith,  of  Teignmouth,  re- 
ported to  the  British  Medical  Journal  *  that  he  had 
found  a  means  of  rendering  milk  digestible  and  accept- 
able to  persons  who  could  not  digest  it  in  its  plain 
state  by  aerating  it  in  a  seltzogene — after  boiling  it 
and  adding  a  small  quantity  of  sodium  bicarbonate. 
He  describes  his  method  of  doing  this  in  the  journal 
referred  to. 

The  tendency  to  restrict  patients  who  suffer  from 
gastric  catarrh  to  farinaceous  foods  is  often  a  great 
error,  for  in  numerous  instances  such  foods  lead  to 
the  formation  of  much  lactic  and  butyric  acids  in  the 
stomach,  and  help  to  aggravate  the  evil  they  are 
intended  to  mitigate.  When,  therefore,  we  prescribe 
farinaceous  foods,  we  should  carefully  watch  for  any 
sign  of  acid  fermentation,  and,  in  that  case,  change  to 
other  food.  In  cases  where  they  do  not  disagree  they 
are  valuable  in  moderate  quantity;  and  light  puddings 
made  with  arrowroot,  sago,  vermicelli,  or  ground  rice, 
or  clear  meat-soups,  slightly  thickened  with  either  of 
these,  are  useful  articles  of  diet  in  such  cases. 

There  is  often  a  difficulty  in  digesting  certain 
kinds  of  bread  in  persons  with  gastric  catarrh,  and 
it  is  not  always  easy  to  say  why ;  but  it  will  be  found 
that  bread  obtained  from  the  best  bakers — bakers 
who  are  well  known  for  the  good  quality  of  their 
bread,  and  who  take  pains  in  its  manufacture — will 
often  be  readily  digested,  whereas  bread  obtained 
indiscriminately  will  disagree. 

Some  kinds  of  whole-meal  bread,  and  of  brown 
bread,  now  so  much  in  vogue,  we  have  found  produce 

•  British  Medical  Journal,  July  17,  1893,  p.  12. 


336  Food  in  Disease.  [Pan  11. 

gastric  U'ritation  and  acid  fermentation,  in  certain 
cases,  when  the  finest  and  lightest  and  best-made 
wheaten  bread  has,  in  small  quantity,  agreed  perfectly. 

Thin  dry  toast  will  also  often  agree  well  when 
ordinary  bread  will  not. 

A  good  bread  should  be  light  and  porous,  and 
should  crumble  to  jneces  readily  in  the  mouth,  and 
not  form  there  an  adhesive,  sticky  mass. 

All  fat  meat  and  sauces  must  he  a\oided,  all  meat 
must  be  well  masticated  or  mechanically  reduced  to 
pulp,  and  taken  in  small  quantities  at  a  time.  The 
digestion  of  animal  food  is  certainly  facilitated  by 
taking  at  the  same  time  a  dose  of  glycerin  of  pepsin 
or  of  the  liquor  pepticus  of  Benger. 

When  solid  animal  food  is  not  well  borne,  con- 
centrated meat-soups  containing  a  little  of  the  crumb 
of  stale  bread  may  take  its  place  with  advantage.  In 
some  persons,  very  prone  to  the  formation  of  acid, 
the  lean  of  cold  roast  meat  or  fowl  finely  divided  and 
taken  with  a  very  little  white  breatl  will  sometimes 
suit  better  than  any  other  food. 

It  has  been  noticed  by  many,  and  especially  by 
Niemeyer,  that  some  dys|)eptics  can  digest  salt  and 
smoked  meats  better  than  fresh  ones;  and  the  explan- 
ation of  this  is  that  these  preserved  meats  are  less 
readily  decomposed,  and  do  not  give  rise  to  acid 
fermentation  in  the  stomach.  Niemeyer  mentions 
that  one  of  his  patients  who  suflTered  from  chronic 
gastric  catarrh,  with  great  tendency  to  acidity,  knew 
exactly  when  he  must  abandon  all  other  food,  and 
limit  himself  to  the  use  of  lean  and  smoked  ham,  sea- 
biscuit,  and  a  little  Hungaiian  wine. 

Lightly-boiled  eggs  area  useful  food  in  these  cases. 
It  is  best,  however,  that  they  should  not  be  quite 
raised  to  the  boiling-point.  They  should  be  put  in 
water  that  is  just  boiling,  then  removed  from  the  fire, 
but  allowed  to  stand  near  it  so  as  to  maintain  the 
temperature  of  the  water  near  the  boiling-point,  for 
three  to  five  minutes.  Cooked  in  this  way  the  albu- 
men will  remain  semi-fluid,  though  opaque. 


Chap.  II.]  Ulcer  of  the  Stomach.  337 

One  of  tlie  most  important  points,  however,  is  to 
make  the  diet  as  spare  as  possible,  so  as  to  reduce  the 
labour  of  stomach  digestion  to  the  minimum  com- 
patible with  the  adequate  iiutiition  of  the  body.  And 
as  the  process  of  digestion  is  slow  in  these  cases, 
ample  time  should  be  allowed  for  the  complete 
digestion  of  each  meal.  It  is  advisable  also  that  the 
food,  whether  animal  or  vegetable,  should  be  small  in 
bulk,  and  this  can  be  secured  by  carefully  selecting 
the  best  portions  of  the  lean  of  meat,  chicken,  game, 
or  tish,  and,  if  necessary,  causing  them  to  be  finely 
divided.  A  certain  amount  of  sound  ripe  fruit  and 
jnirees  of  fresh  vegetables  are  useful  to  counteract  the 
tendency  to  constipation. 

As  we  have  ali'eady  pointed  out,  the  gastric 
mucous  membrane  is,  in  these  cases,  covered  with  a 
coating  of  adherent  ropy  uuicus,  and  it  is  on  this 
account  that  a  glass  of  warm  alkaline  water,  like  that 
of  Vichy  or  Vals,  taken  half  an  hour  before  a  meal, 
promotes  its  digestion,  by  loosening  and  washing 
away  this  tenacious  layer  of  mucus,  clogging,  as  it 
does,  the  orifices  of  the  gastric  glajids.  We  may 
mention  here  tliat  a  course  of  the  warm  alkaline 
sodium  sulphate  waters  of  Carlsbad,  together  with 
the  strict  diet  there  enforced,  effects  some  l)rilliant 
cures  in  obstinate  cases  of  chronic  gastric  catarrh. 
The  employment  of  an  exclusively  mi/k  diet  in  the 
chi'onic  gastric  catarrh  induced  by  abuse  of  alcohol 
is  strongly  advocated  by  Dujardin-Beaumetz,  who 
also  insists  on  the  value  of  the  addition  to  the  milk 
of  some  fdkaline  v/ater  or  sodium  bicar])onate.* 

The  rules  that  should  direct  the  dietetic  treatnu  nt 
of  ciises  of  ulcer  of  tlic  stoiiiacii  are  few  and 
simple. 

In  the  first  place,  we  must  avoid  all  food  that 
ciin,  either  mechanically  or  chemically,  irritate  tlio 
surface  of  the  ulcer. 

Secondly,  we  must  avoid  the  use  of  food  (hat  is 
calculated  to  stimulate  the  acid  secretions  of  the 
*  "L'llygiene  Alimeutaire,"  p.  211. 


338  Food  in  Disease.  [Part  11. 

stomach,  for  this  will  act  as  an  irritant  to  the  raw, 
ulcerated  surface. 

Thirdly,  we  must  avoid  distending  the  stomach 
with  much  food  at  a  time,  for  by  maintaining  the 
stomach  in  a  contracted  state  its  mucous  membrane 
is  thrown  into  folds,  so  that  the  margins  of  the  ulcer 
are  relaxed  and  its  extent  is  diminished — conditions 
favourable  to  filling  up  and  healing  of  the  ulcer. 

Fourthly,  any  excitement  of  the  muscular  move- 
ments of  the  stomach  should  be,  so  far  as  possible, 
prevented. 

Lastly,  in  cases  of  perforating  ulcer,  where  severe 
and  dangerous  haemorrhages  have  occurred  and  may 
recur,  the  stomach  should  be  kept  absolutely  at  rest, 
for  two  or  three  days  at  least,  and  the  patient  fed 
with  nutrient  enema ta,  to  which,  if  necessary,  a  little 
brandy  or  port  wine  may  be  added,  allowing  only  a  few 
fragments  of  ice  to  be  sucked  in  order  to  allay  thirst. 

In  most  ordinary  cases,  restriction  to  an  exclu- 
sively milk  diet  will  answer  the  indications  given 
above.  It  is  extremely  desirable,  however,  that  the 
stomach  should  not  have  to  deal  with  any  consider- 
able mass  of  milk-curd,  and  to  prevent  any  firm 
coagulation  of  the  casein  of  milk  in  this  organ  we 
should  add  some  alkaline  carbonate  or  alkaline  solu- 
tion to  the  milk.  In  many  instances,  mixing  the 
milk  with  an  equal  quantity  of  lime-water  is  suf- 
ficient, or  Vichy  water  may  be  used  instead.  A  good 
plan,  however,  as  we  have  already  said,  is  to  add  to 
each  cup  of  milk  (4  oz.)  a  powder  composed  of  10 
gi'ains  of  bicarbonate  of  soda,  5  grains  of  light 
magnesia,  and  10  grains  of  common  salt,  and  a 
tablespoonful  or  two  of  water  (iced,  if  necessary). 
This  may  be  sipped  slowly  every  two  or  three  hours. 
If  the  patient's  state  seems  to  need  it,  an  egg  may  be 
beaten  up  with  two  tablespoonfuls  of  hot  water, 
allowed  to  cool,  and  added  to  the  cup  of  milk  twice  a 
day ;  or  about  an  ounce  of  the  crumb  of  a  stale  roD, 
well  soaked  previously  in  hot  water,  may  be  mixed 
with  the  milk  two  or  three  times  daily. 


Chap,  ii.i         Ulcer  of  the  Stomach.  339 

To  avoid  the  curdling  of  the  milk  in  the  stomach, 
some  physicians  give  butter-milk ;  and  some  patients 
take  this  well,  but  others  object  to  its  sour  taste. 
Niemeyer  found  Malt  Extract  a  u.seful  food  in  these 
cases ;  and,  as  a  good  form  of  vegetable  food,  jrwree  of 
potatoes. 

If  there  is  a  distinct  intolerance  of  milk  diet, 
small  quantities  of  meat  or  chicken  may  be  given, 
finely  divided  or  reduced  to  a  pulp  (the  lean  only), 
and  mixed  with  a  little  weak  broth  or  consomme* 

In  Germany,  Leube's  Soluble  Meatf  is  much  used 
in  such  cases.  "  Its  constituents  are,  for  the  most 
part,  ready  for  absorption  without  any  particular 
action  of  the  gastric  juice,  so  that  in  giving  it  there 
is  no  long-continued  secretion  of  gastric  juice — a 
circumstance,  doubtless,  of  no  small  importance  for 
the  healing  of  the  ulcers. "J  Leube  gives  his  patients 
some  milk  in  addition,  and  also  some  well  soaked 
bread.  The  Soluble  Meat  is  mixed  with  sligiitly 
salted  broth  and  taken  lukewarm. 

A  very  nutritious  food  which  may  from  time  to 
time  be  given  these  patients  consists  of  a  small  tea- 
cupful  of  consomme  to  which  the  yolk  of  an  egg  has 
been  added  and  a  little  well-soaked  bread-crumb. 

In  those  serious  cases  in  which,  from  fear  of 
haemorrhage,  it  is  necessary  to  feed  the  patients  by 
nutrient  enemata,  it  is  desirable  to  keep  them  in  bed, 
in  order  to  lessen  the  nutritive  wants  of  the  system 
as  far  as  possible. 

If,  after  a  fortnight  or  three  weeks  of  this  strict 
feeding,  the  symptoms  of  the  disease  have  disappeared, 
we  should  permit  a  gradual  return  to  more  solid  food 
— the  lean  of  tender  boiled  mutton  or  chicken,  boiled 
sole  or  whiting,  light  milk  puddings,  and  vegetable 
2)ur4es ;    but    we    should    be    careful    to    limit   the 

*  In  France  powdered  meat  is  a  common  article  of  invalid  con- 
sumption, and  the  poudre  de  viande  of  Rousseau  is  one  of  the  best. 

t  Its  preparation  is  described  at  page  .543. 

+  "Dietary  of  the  Sick,"  p.  251;  Ziemssen's  "Handbook  of 
General  Therapeutics." 

W  2 


34°  Food  in  Disease.  (Pan  ii. 

amount  taken,  strictly,  to  that  required  to  satisfy 
the  physiological  needs  of  the  body  ;  and  these, 
it  must  be  remembered,  will  be  smaller  than  in 
ordinary  active  life. 

Stimulating  beverages  taken  by  the  mouth  should 
be  wholly  avoided.  A  little  weak  tea,  with  milk, 
may  be  permitted  in  some  instances. 

Leube  has  pointed  out  that  gruel  made  from 
coarse  groats,  or  porridge,  should  be  specially  avoided, 
as  the  coarse  particles  coming  into  contact  with  the 
ulcerated  surface  may  set  up  great  iiritation. 

In  cancer  of  tlie  stoiiiacli,  the  comfort  of  the 
patient,  and  the  prolongation  of  his  life,  are  greatly 
dependent  on  judicious  feeding. 

The  indications  are  to  supply  as  much  nourish- 
ment to  the  body  as  will  adequately  meet  tlie  nutiitive 
demands  and  check  the  progressive  emaciation,  while 
at  the  same  time  we  reduce  to  a  minimum  the  work 
of  gastric  digestion  and  the  pain  that  is  usually 
attendant  thereon.  To  do  this  we  must  give  food  in 
such  a  form  that  it  can  either  be  readily  absorbed  by 
the  vessels  of  the  stomach  itself,  and  cause  little  or 
no  irritation  by  its  presence  there,  or  food  that  can 
readily  pass  out  of  the  stomach,  and  be  absorbed 
lower  down  in  the  alimentary  canal.  But  we  must 
not  under-estimate  the  digestive  capacity  of  the 
stomach  itself  in  all  patients  with  gastric  carci- 
noma, for  in  some  it  is  veiy  considerable  ;  and  we 
have  known  cases  of  scirrhus  pylorus  in  which  a  fair 
amount  of  solid  animal  food  was  taken  and  digested 
for  many  years,  with  only  occasional  attacks  of 
digestive  trouble.  We  have  i-cported  a  very  re- 
markable case  of  this  kind  ;  *  and  Dujardin-Beaumetz 
cites  the  case  of  a  man  whom  he  had  under  his  care 
in  the  Hopital  Cochin  with  a  large  carcinomatous 
growth  in  the  stomach  who  implored  that  he  might 
be  allowed  a  salad  with  hard  boiled  eggs  daily,  and 
for  a  month  that  indigestible  food  formed  his  sole 
nourishment.! 

•  La^xcet,  Jan.  2&th,  1876.       +  "L'Hvgiene  Alimentaire,"  p.  209. 


Chap.  II.)        Cancer  of  the  Stomach.  341 

One  important  point  to  keep  in  view  in  the  feed- 
ing of  cases  of  cancerous  stricture  of  the  pylorus  is  to 
give  such  food  as  can  be  digested  and  absorbed  in  the 
stomach  (or  predigested  food),  and  that  has  not  to  pass 
through  the  narrowed  pyloric  outlet  in  order  to  be 
digested  lower  down.  It  is,  therefore,  necessary  to 
avoid,  in  these  cases,  starchy  farinaceous  foods,  unless 
they  are  predigested,  for  they  cannot  be  digested  in 
tlie  stomach,  and  there  is  difficulty  in  their  passing 
out  of  tliat  organ  ;  the  result  is  that  they  are  retained 
there,  and  give  rise  to  the  development  of  lactic  and 
butyric  acids,  set  up  much  pain,  and  lead  to  trouble- 
some nausea  and  vomiting. 

We  have  seen  such  patients  fed  with  soft  fari- 
naceous foods  with  the  idea  that  they  were  bland  and 
unirritating,  the  consequence  being  that  fi'equent 
vomiting  and  much  gastric  distress  were  induced. 
Upon  an  entire  suppression  of  the  farinaceous  foods 
and  an  entire  restriction  to  concentrated  meat 
solutions  and  foods  that  could  be  absorbed  in  the 
stomach,  or,  on  account  of  their  perfect  fluidity,  could 
pass  readily  into  the  small  intestine,  the  vomiting  and 
distress  have  immediately  ceased. 

If  the  cancerous  growth  should  involve  some 
other  I'egion  of  the  stomach,  there  is  then  not  the 
same  objection  to  the  carbo-hydiates,  because  there 
is  not  the  same  risk  of  their  being  retained  long 
enough  to  undergo  abnormal  decomposition  in  the 
stomach. 

Food  in  cancer  of  tlie  stomach,  speaking  generally, 
should  bo  riuid,  and  sufficiently  concentrated  to  supply 
the  necessary  nourishment  in  a  small  bulk.  When 
milk  is  well  borne,  no  better  food  can  be  taken.  It 
is  well,  however,  to  dilute  it  slightly  with  some 
alkaline  water  ;  and  peptoni.sed  milk  will  often  be 
found  to  agree  when  ordinary  fresh  milk  will  not. 

Should  any  considerable  haemorrhage  from  the 
stomach  occur  during  the  course  of  the  di.sease,  it 
may  be  necessary  to  limit  the  administration  of  food 
for  a  time  entirely  to  nutrient  enemata,  so  as  to  keep 


342  Food  in  Disease.  [Part  ii. 

the  stomach  free  from  any  irritation  oi*  functional 
excitement. 

We  are  quite  in  accord  with  Professor  Bauer  in 
his  contention  that  "  in  carcinoma  of  the  stomach, 
animal,  highly  albuminous  foods — as  milk,  eggs,  and 
tender  meat — are  decidedly  preferable  to  those  which, 
from  the  large  amount  of  hydrocarbons  they  contain, 
are  easily  prone  to  abnormal  and  acid  fermentation."* 
And  we  entirely  doubt  the  accuracy  of  Dujardin- 
Beaumetz's  recommendation  (which  he  appears  to 
found  on  the  controverted  statement  of  Van  Velden, 
that  in  carcinoma  of  the  stomach  there  is  an  absence 
of  hydrochloric  acid  in  the  gastric  juice)  that  vegetable 
and  farinaceous  purees  are  better  than  nitrogenous 
food.  We  are  satisfied,  as  we  have  already  stated, 
tliat  this  is  certainly  erroneous  when  stricture  of  the 
pylorus  exists. 

All  physicians  are  agreed  that  whatever  food  such 
patients  take — and  their  own  feelings  may  be  to  a 
certain  extent  consulted — it  must  always  be  in  small 
quantity  at  a  time. 

As  a  beverage,  a  little  red  wine  diluted  with 
water  appears  to  be  well  borne ;  beer  and  spirits 
should  be  avoided,  and  all  sweet  and  eflfervescing 
wines. 

Oppolzer  has  advised  the  use  of  sour  milk  or 
butter-milk  as  less  prone  than  fresh  milk  to  form  a 
hard,  irritating  coagiilum  in  the  stomach.  In  some 
few  instances  a  dry  diet  has  been  found  to  agree 
better  than  a  fluid  one. 

Each  individual  case  must  be  carefully  studied, 
and  much,  no  doubt,  of  the  facility  with  which  different 
articles  of  food  are  digested  depends  on  the  seat  of 
the  disease  and  the  secondary  changes  it  may  have 
given  rise  to,  such  as  dilatation,  etc. 

If  the  cancerous  growth  should  have  attacked  the 
cardiac  orifice,  then  nothing  but  fluid  food  should 
be  given,  as  solid  food  would  be  arrested  above  the 

•  "The  Dietary  of  the  Sick,"  p.  253;  Ziemssen's  "Handbook 
of  General  Therapeatics." 


Chap. II.]     Dilatation  OF  the  Stomach.  343 

stricture  and  cause  dilatation  of  the  oesophagus.  If 
the  stricture  is  considerable,  it  may  be  advisable  to 
introduce  food  into  the  stomach  through  the  tube 
of  a  stomach-pump,  or  to  have  recourse  to  rectal 
alimentation. 

We  shall  next  consider  the  diet  most  appropriate 
to  cases  of  dilatation  of  the  stomach. 

This  condition  of  the  stomach  is  most  commonly 
due  to  the  existence  of  stricture  at  or  near  its  outlet, 
but  it  may  also  be  produced  by  other  causes  ;  it  may 
depend  on  want  of  tone  and  loss  of  contractile  power 
in  its  muscular  coat,  and  this  may  be  the  result 
either  of  general  debility,  defective  innervation,  or 
long- continued  gastric  catarrh.  It  may  exist  as  a 
part  of  that  general  exhaustion  of  the  system  that 
follows  a  long-protracted  illness.  It  not  unfrequently 
arises  as  the  more  or  less  direct  consequence  of 
habitual  over-distension  of  the  stomach  with  food 
and  drink,  and  particularly  from  the  excessive  use  of 
effervescing  drinks ;  and  it  may  also  occur  in  con- 
nection with  certain  other  less  obvious  morbid  con- 
ditions. But  our  present  purpose  is  not  to  investi- 
gate its  mode  of  origin,  but  to  consider  what  are 
the  dietetic  measures  by  which  it  may  be  cured  or 
ameliorated. 

Mechanically  emptying  and  then  washing  out  the 
stomach  —  lavage  d'estomac  —  has  been  extensively 
advocated  and  practised  in  the  treatment  of  dilata- 
tion ;  but,  apart  from  the  circumstance  that  many 
patients  have  a  great  dislike  of  this  mode  of  treat- 
ment, there  can  be  no  doubt  that  it  has  been  had 
recourse  to  in  many  slight  cases  where  careful  dietetic 
measures  would  have  sufficed. 

One  of  the  first  dietetic  rules  to  be  a])plied  to  the 
treatment  of  stomach  dilatation  is  rigidly  to  forl)id 
overloading  the  dilated  organ.  That  is,  of  course,  of 
the  greatest  importance.  The  food  should,  therefore, 
be  concentrated  and  of  small  bulk.  We  should  also 
strictly  limit  the  supply  of  liqxiids,  especially  in  those 
cases  where  there  is  a  tendency  to  take   an  excess. 


344  Food  in  Disease.  [Panii. 

We  need  not,  liowover,  posh  tlie  adoption  of  a  "dry 
diet"  to  the  extent  that  lias  been  advocated  Ity  some 
German  physiciai^s,  Bartels  amongst  the  nnml)er.  But 
we  should  strictly  limit  the  quantity  of  fluid  taken 
roitlb  the  food  to  six  or  eight  ounces.  When  there  is  a 
great  craving  for  fluids,  the  best  ])lan  is  to  let  the 
patient  sip  a  teacupful  or  more  of  hot  water  half  an 
hour  before  a  meal  ;  by  this  means  we  shall  lessen  the 
desire  to  drink  duiing  the  meal,  and  at  such  a  period 
fluid  is  rapidly  ahsorlied  by  the  stomach. 

The  quantity  of  fluid  taken  by  various  individuals 
differs  within  very  vnde  limits,  and  is  often  greatly  in 
excess  of  their  ])hysiological  requirement. 

As  it  is  desiraljle  that  the  food  .should  be  concen- 
trated, it  must  therefore  bo  chiefly  animal.  The  lean 
of  meat  from  which  all  fibrous  and  tendinous  struc- 
tures have  Vjeen  removed  is  the  best,  and  this  may  be 
minced  fine  before  cooking  in  the  manner  recom- 
mended by  the  advocates  of  what  is  known  as  the 
"  Salisbury  "  method,  to  which  further  reference  will 
hereafter  be  made. 

Starchy  foods  (carbo-hydrates)  should  l)e  taken 
only  in  small  quantity;  they  are  prone  to  lingei-  in 
and  set  up  abnormal  fermentations  in  the  dilated 
stomach.  jNIost  vegetable  substances  calculated  to 
give  rise  to  flatulence  must  be  discarded  ;  fresh  veget- 
ables must  only  be  taken  in  limited  quantity,  and  in 
the  most  concentrated  and  digestible  form.  Those 
that  can  be  taken  in  the  form  of  purees  are  the  best. 

A  certain  amount  of  carbo-hydrates  is,  of  course, 
essential  to  a  perfect  dietaiy,  and  so  also  is  a  certain 
proportion  of  green  A'egetables ;  so  that  we  must  not 
altogether  exclude  a  moderate  proportion  of  white 
bread  (not  neiv),  nor  a  litth;  fresh  vegetables.  Some 
of  the  light  farinaceous  foods  may  also  be  taken  in 
small  quantity  at  a  time,  as  tapioca,  sago,  rice,  and 
macaroni,  but  these  must  not  be  taken  at  the  same 
time  as  animal  foods. 

Only  in  .severe  ca.ses,  associated  with  troublesome 
vomiting,  is  it  necessary  to  adopt  for  a  time  a  strictly 


Chap.  II.  1      Dilatation  of  the  Stomach.  345 

milk  diet,  and  in  these  cases  the  milk  should  be  given 
with  crushed  ice. 

G.  See  protests  against  tlie  rigidly  dry  diet  advo- 
cated by  some,  and  maintains  that  it  is  injurious 
when  carried  to  an  extreme,  and  remarks  that  he  has 
seen  it  lead  to  great  emaciation.  He  adds  :  "  It  is 
not  water  tliat  dilates  the  stomach  ;  it  does  not  stay 
there,  it  is  in  part  absorbed,  but  the  greater  part 
passes  rapidly  into  the  intestine," — which  is  quite 
true  of  water  taken,  as  we  have  suggested,  by  itself 
and  when  the  stomach  is  empty  ;  but  it  is  scarcely 
tnie  of  fluids  that  ai*e  taken  with  food.  He,  however, 
admits  that  food  containing  much  water,  as  fresh 
vegetables  and  fruit,  sliould  be  abstained  from,  as 
they  arc  cumbrous  in  bulk  and  contain  but  little 
nourishment.  He  prescribes  the  most  nutritious 
forms  of  animal  food — fish,  not  ricli  in  fat,  cheese, 
eggs,  and  such  farinaceous  foods  as  are  richest  in 
nitrogen.* 

Huchard  has  advocated  the  strict  limitation  of 
liquids,  and  allows  a  glass  and  a  half  only  at  each 
meal  ;  all  food  substances  and  fruits  containing  nmch 
water  are  to  be  rejected,  and  only  very  thick  soups 
to  be  permitted  :  roast  meat,  eggs,  and  tlie  drier  kinds 
of  vegetables  he  approves  of. 

Professor  Bouc])ard  allows  12  oz.  only  of  fluid  at 
breakfast  and  at  dinner,  and  these  must  be  non- 
fermenting  ;  red  svines  he  proliibits,  but  allows 
mineral  (table)  wator.s,  water  containing  J  of  beer  (!), 
or  a  quarter  pint  of  white  wine,  or  a  dessertspoonful 
of  brandy.     Xo  drink  is  to  be  taken  between  meals. 

Fatty  foods  are  to  be  abandoned  ;  the  crust  of 
bread  or  toast  only  is  to  be  eaten.  The  meals  should 
be  as  far  apart  as  possible;  nine  hours  should  inter- 
vene between  breakfast  and  dinner  and  tifteen  between 
dinner  and  breakfast !  These  rules  are  certainly  much 
too  absolute. 

The  dietary  sketched   by  Dujardin-Beaumetzf  for 

•  G.  See,  "Du  "egiine  Alimentaire." 
t  "L'Hygi^ne  Alimentaire." 


346  Food  in  Disease.  [Partii. 

those  suffering  from  dilated  stomachs  is  far  more 
liberal :  he  allows  the  usual  early  breakfast  at  7  a.m., 
the  dejeuner  cb  la  fourchette  at  11  a.ni.,  and  dinner  at 
7.30  p.m.  ;  but  he  forbids  any  eating  between  these 
meals. 

He  permits  all  hinds  of  food,  but  gives  the  pre- 
ference to  meat,  fish,  eggs,  and  farinaceous  foods  ; 
and  he  does  not  prohibit  green  vegetables  or  fruit. 
He  enters,  however,  into  certain  details,  such  as  the 
following  : — The  meat  should  be  well  cooked,  and 
braised  rather  than  roasted  ;  fish  should  be  simply 
boiled  ;  eggs  should  be  cooked  very  lightly. 

The  farinaceous  foods  should  be  in  the  form  of 
purees — potatoes,  haricots,  lentils  ;  also  macaroni  and 
vermicelli. 

The  green  vegetables  should  be  well  cooked  and 
served  as  purees — carrots,  turnips,  green  peas,  spinach, 
French  beans,  cress  and  salad,  cooked.  Fruit  should 
be  stewed,  except  strawberries  and  grapes. 

Bread  must  be  toasted  ;  no  fluid  soups. 

For  beverage,  at  each  meal,  about  10  oz.  of  white 
wine,  made  very  weak  with  water ;  no  undiluted 
wine. 

It  is  a  good  plan,  as  Sir  William  Broad  bent 
suggests,  for  patients  with  dilatation  of  the  stomach 
to  drink  a  large  glass  of  hot  water  on  going  to  bed.* 

We  now  pass  on  to  consider  the  most  suitable 
dietetic  treatment  of  those  vaguer  forms  of  stomach 
disorder  which  are  grouped  under  the  term  dj'S- 
pepsia  or  indig^cstion,  and  which  cannot  be 
referred  to  any  of  the  definite  morbid  states  of 
which  we  have  been  speaking. 

These  disorders  frequently  occur  in  the  form  of 
temporary  attacks,  and  can  often  be  traced  to  a  definite 
exciting  cause ;  and  this  will  often  be  found  to  be 
some  particular  error  in  diet,  or  some  faulty  method 
of  taking  food,  or  perhaps  overwork  and  mental 
anxiety,  or  some  inattention  to  the  action  of  the 
•  Britigh  Medical  Journal,  Dec.  9,  189.3. 


Chap.  II.]  Indigestion.  347 

bowels ;  or  the  stomach  disorder  may  be  sympathetic 
with  irritation  of  other  organs,  as,  for  example, 
ovarian  and  uterine  irritation  in  the  female,  and 
over-sexual  indulgence  in  both  sexes. 

The  more  chronic  fonns  may  be  associated  with 

(1)  a  hypersesthesia  of  the  gastric  mucous  membrane; 

(2)  insiifficient  amount  or  altered  quality  of  gastric 
secretion ;  (3)  imperfect  disintegration  of  the  food 
in  the  mouth;  or  (4)  loss  of  tone  in  the  muscular 
coat  of  stomach. 

The  symptoms  are  so  well  known  as  scarcely  to 
need  repetition  here,  and  are  much  the  same  as  those 
of  chronic  gastric  catarrh  already  enumerated  :  a  sense 
of  weight  and  discomfort  in  the  epigastrium  coming  on 
soon  after  taking  food,  and  in  some  instances  (hyper- 
sesthesia of  gastric  mucous  membrane)  amounting  to 
acute  pain  ;  flatulent  distension  of  stomach  and  intes- 
tines, often  accompanied  with  sighing,  and  by  dyspnoea 
and  palpitation  on  exertion,  due  to  pressure  upwards 
against  the  diaphragm  of  the  distended  stomach  ; 
eructations  of  the  acid  contents  of  the  stomach,  caus- 
ing a  burning  pain  about  the  cardiac  orifice  of  the 
stomach,  or  "  heartburn.''  These  symptoms  are  often 
accompanied  either  by  headache  and  general  lassitude, 
or  by  restlessness  and  irritability.  Occasionally  there 
may  be  vomiting. 

In  all  such  cases  our  first  duty  is  to  inquire  care- 
fully into  tlie  habits  of  the  patient,  both  as  to  the 
food  he  takes  and  as  to  his  manner  of  taking  it. 

Imperfect  mastication,  from  haste  in  feeding,  or 
from  defective  teeth,  or  from  habitually  taking  food 
difficult  of  disintegration  in  the  mouth,  is,  perhaps, 
one  of  the  most  common  causes  of  dyspepsia  in  persons 
of  fee])le  digestion  or  of  advanced  age.  It  is  import- 
ant to  remember  that  the  digestive  function,  the 
function  of  the  solution  of  the  food,  begins  in  the, 
month,  with  the  very  important  acts  of  mastication 
and  insalivation.  The  mechanical  disintegration  of 
the  food  by  the  action  of  the  teeth  and  jaws  is  essen- 
tial  to   its  complete   digestion  lower  down   in    the 


348  Food  in  Disease.  [Part  ii. 

stomach  and  intestines ;  for  without  this  reduction  of 
the  food  into  small  fragments  the  digestive  juices 
cannot  come  into  close  contact  with  all  its  parts,  and 
so  effectively  exercise  their  solvent  chemical  power 
upon  it.  And  it  should  be  noted  that,  whereas  if  the 
food  escapes  solution  by  the  chemical  action  of  the 
gastric  juice  in  the  stomach,  it  encounters  other 
digestive  juices,  after  it  has  left  tlie  stomach,  which 
can,  to  fome  extent,  supplement  its  action :  it  is  not 
so  with  mastication;  once  the  food  has  passed  out 
of  the  mouth  there  is  no  further  op])ortunity  afforded 
for  supplementary  mechanical  disintegration.  The 
importance  of  this  initial  act  of  digestion,  as  well  as 
the  necessity  of  a  certain  amount  of  attention  being 
paid  to  the  act  of  feeding,  should  be  pointed  out  to  all 
persons  with  feeble  stomachs.  Hence  the  value  of 
agreeahly-Jlavoured  food  which  attracts  the  attention, 
and  upon  which  it  is  willing  to  linger.  When  there 
is  a  difficulty  in  masticating  food  from  defective  teeth, 
or  in  any  case  where  due  mastication  is  obviously 
neglected,  food  should  be  given  that  does  not  I'equire 
much  mechanical  effort  for  its  disintegration,  e.g.  the 
crumb  of  stale  bread,  dry  toast,  some  kinds  of  biscuit, 
which  crumble  down  and  disintegrate  readily,  whereas 
new  bread  is  apt  to  form  tough  coherent  masses  in 
the  mouth.  Vegetables  should  be  evenly  mashed  or 
reduced  to  the  form  of  purees  ;  potatoes,  especially, 
unless  very  "mealy,"  are  apt  to  escape  thorough 
mastication,  and  to  be  swallowed  in  lumps  which  are 
likely  to  prove  a  source  of  irritation  and  of  abnormal 
decomposition  lower  down  in  the  alimentary  canal. 
Fat  also  should  not  be  eaten  in  lumps,  but  should  be 
finely  divided  and  mixed  with  some  other  food  which 
will  keep  the  fragments  apart.  "  Bread  and  butter  " 
is  an  example  of  this.  If  the  teeth  are  at  fault,  the 
meat  taken  should  be  first  reduced  to  a  pulp,  or 
minced,  or  pounded  (small  machines  exist  for  this 
purpose).* 

Persons  with  feeble  digestions  should  prefer  the 
*  Set  account  of  "  Salisbury  "  method,  pages  451,  455. 


Chap.  II.]  Indigestion.  349 

shcn'ter-fihered  and  more  easily  disintegrated  meats  and 
fish  :  mutton,  chicken,  pheasant,  partridge,  are  better 
than  beef,  goose,  duck,  wild-fowl,  etc.  Veal  and  pork 
are  notoriously  ditlicult  of  digestion,  and  lauib  and 
rabbit  are  not  so  easily  digested  as  some  persons  be- 
lieve. Of  fish,  the  sole,  whiting,  and  flounder,  when 
plainly  grilled  or  boiled,  are  far  more  digestible  than 
the  firmer-fleshed  and  richer  fish. 

Grilled  (not  fried)  fat  bacon  eaten  with  dry  toast 
often  proves  an  easily  digested  and  good  form  of  fatty 
food.  It  disintegrates  readily,  is  savoury,  and  mixes 
well  with  bread ;  accompanied  by  the  yolks  of  one  or 
two  poacheJ  eggs,  it  forms  a  nutritious  and  compact 
meal. 

As  we  have  before  had  occasion  to  remark,  any 
food  saturated  with  fat,  which  hinders  its  penetration 
by  the  gastric  juice,  such  as  buttered  toast,  muffins, 
pastry,  etc.,  and  sweet  dishes  that  are  apt  to  undergo 
acid  fermentation,  and  unripe  acid  fruits,  nuts,  and 
the  hard  coverings  of  vegetables  containing  nmch 
cellulose,  are  difiicult  of  digestion  and  must  be 
avoided. 

It  is  exceedingly  important  that  the  food  of  the 
dyspeptic  should  be  carefully  and  skilfu  ly  cooked 
and  agreeably  flavoured  ;  if  food  is  made  palatable 
and  appetising  it  stimulates  the  nervous  system,  and 
so  promotes  gastric  secretion  and  digestion  ;  (jrilled 
meats  are  perhaps  the  most  digestible  and  savoury. 

As  to  sauces,  it  is  best  for  the  dyspeptic  to  avoid 
all  rich  sauces  entirely,  and  when  butter  is  required, 
as  with  fish,  to  use  plain  fresh  butter. 

The  intligestibility  of  bread,  or  rather  of  certain 
kinds  of  bread,  and  of  too  large  a  quantity  of  bicad,  is 
often  overlooked. 

A  bread  which  breaks  "  short,"  is  porous,  and 
crumbles  easily,  which  is  not  too  moist,  and  yet  wliich 
docs  not  dry  too  quickly,  and  which  does  not  mass 
together  in  the  mouth  in  mastication,  is  the  best.  It 
will  be  found,  as  we  have  said  before,  that  the  bread 
of  some  bakers  is  far  more  diufe.->tible  than  that  of 


350  Food  in  Disease.  (Pan  ii. 

others,  although  apparently  of  the  same  quality.  It 
is  owing  to  the  indigestibility  of  baker's  bread  that  so 
many  persons  eat  dry  toast.  Some  of  the  whole-meal 
bread,  now  so  largely  advocated,  although  extremely 
pleasant  to  eat,  and  undoubtedly  of  high  nutritive 
value,  we  have  found  prove  very  indigestible  to 
persons  of  feeble  digestion. 

Another  point  of  extreme  importartce  to  the  dys- 
peptic is  that  the  meals  should  be  small,  or  very 
moderate  in  quantity.  Our  object  should  be  to  select 
a  diet  which,  while  it  affords  the  necessary  amount  of 
nourishment  to  the  body,  imposes  the  smallest  amount 
of  labour  on  the  stomach. 

Small  meals,  slowly  and  deliberately  eaten — that 
is  a  golden  precept  for  the  feeble  of  digestion. 

A  sufficient  amount  of  time  should  also  be  allowed 
between  the  meals  to  permit  of  the  complete  digestion 
of  one  meal  before  the  next  is  taken.  When  the 
patient  is  unable  to  take  any  solid  food,  then  no  doubt 
it  is  necessary  to  take  small  quantities  of  fluid  food  at 
short  intervals ;  but  when  solid  food  is  taken,  as  at  an 
ordinary  meal,  it  must  be  remembered  that  from  five 
to  eight  hours,*  according  to  the  amount  and  nature 
of  the  food,  are  needed  for  its  digestion,  especially  in 
advanced  life,  and  in  the  feeble  and  dyspeptic. 

We  have  had  frequent  occasion  to  observe  how 
dyspeptic  conditions  have  been  excited,  maintained, 
and  aggravated  by  adhering  to  the  habit  of  taking 
food  at  too  short  intervals. 

The  dyspeptic  should  be  cautioned  to  avoid  sitting 
down  to  food  immediately  after  severe  mental  or 
physical  toil,  or  returning  to  work  immediately  after 
a  meal ;  both  nervous  and  circulatory  energy  should 
be  free  to  devote  themselves  to  the  work  of  stomach 

*  Leube  has  shown  that  the  digestion  of  a  meal,  in  health, 
takes  from  four  to  seven  hours,  and  this  has  been  confirmed  by 
other  observers  ;  a  light  breakfast  has  been  found  to  take  four  and 
a  half  hours,  a  full  meal  seven  hours.  But  the  time  required  to 
digest  a  meal  varies  greatly  in  different  persons,  and  in  the  same 
person  under  different  conditions,  and  may  be  sometimes  longer 
and  sometimes  shorter  than  the  time  stated. 


Chap,  ii.i  Indigestion.  351 

digestion,  and  for  that  purpose  they  must  be  relieved 
from  other  labour. 

Emotional  disturbances  are  also  equally  to  be 
avoided,  but  these  are  not  usually  so  completely 
under  our  own  control. 

The  existence  of  faulty  habits  with  regard  to  the 
use  of  stimulating  drinks — as  alcohol,  tea  and  coffee, 
or  the  consumption  of  an  excessive  amount  of  irrita- 
ting condiments,  or  the  abuse  of  tobacco — must  be 
sought  out  and  corrected. 

The  alcoholic  cases  are  the  most  troublesome  to 
deal  with.  When  there  is  a  craving  and  fondness  for 
alcohol,  it  is  best  to  forbid  it  entirely  ;  whereas  in 
non-alcoholic  cases  of  atonic  dyspepsia  a  small  amount 
of  good  pure  wine,  preferably  with  water,  or  a  little 
weak  brandy  or  whisky  and  water  (or,  if  preferred, 
some  effervescing  table  water),  often  serves  as  a 
useful  stimulus  to  gastric  secretion. 

With  respect  to  the  use  of  tea  and  coffee  by 
dyspeptics,  much  difference  of  opinion  exists.  That 
excess  in  either  will  excite  dyspeptic  states  in  some 
j)ersons  under  certain  conditions  is  absolutely  certain. 

We  have  had  occasion  to  note  that  both  these 
beverages  will  cause  dyspepsia  in  persons  when  suffer- 
ing from  mental  worry,  whereas  they  will  not  do  so 
when  this  disturbed  mental  state  has  passed  away. 
Much  also  of  the  dy'^spcpsia  occasioned  by  these 
beverages  depends  on  the  time  at  which  they  are 
taken.  A  person  with  a  feeble  digestion  should  not 
take  them  with  or  soon  after  food  ',  they  will  often 
then  retard  digestion  ;  but  a  small  cup  of  weak  un- 
sweetened tea  or  light  coffee  three  or  four  hours  after 
a  meal  will  not  unfrequently  be  found  to  promote 
the  final  stage  of  stomach  digestion ;  no  food,  how- 
ever, should  be  eaten  at  the  same  time,  as  is  so  com- 
monly done.  In  cases  where  even  at  this  distance  from 
a  meal  they  appear  to  interfere  with  digestion,  it  is  a 
good  plan  to  sip  a  teacupful  of  hot  water  instead. 
Light  China  teas  are  much  less  likely  to  cause 
dyspepsia  than  the  stronger  Indian  kinds. 


352  Food  in  Disease.  [Panii. 

Professor  Sde  is  a  vigorous  advocate  of  tea  as  a 
beverage  in  dyspepsia. 

"  The  best  digestive  beverage,"  he  i>ays,  "  is  tea, 
provided  a  light  infusion  is  made,  and  at  least  a  deini- 
litre  [about  16  oz.]  taken  at  a  time  and  at  a  high 
temperature  ;  at  the  midday  meal  [the  French  "  de- 
jeuner "]  it  will  most  advantageously  tiike  the  place  of 
wine  ;  it  does  not  ferment ;  it  contains  only  traces  of 
tannin,  while  cofl'ee  contains  a  great  deal  more." 
After  referring  to  some  opposing  testimonv,  he  pro- 
ceeds : — "  What  a  sad  future  is  being  prepared  for  us 
by  the  three  daily  cups  of  tea  wliich  I  claim  to  be  the 
best  digestive  and  tlie  surest  means  of  sustaining  intel- 
lectual energy.  Amongst  my  best  friends  may  be 
found  patients  who  for  years  have  followed  stiictly  my 
counsel,  and  are  remarkable  for  their  physical  and 
intellectual  vigour !  "* 

Our  own  personal  experience  teaches  us  that  there 
is  trutli  on  both  sides.  We  have  sutlered  in  times 
past  from  tea-dyspepsia,  but  still  we  diink  tea,  and, 
we  think,  with  advantage,  and  are  able  even  to  find 
in  tea  a  stiumlant  to  digestion ;  but  we  have  learnt 
by  experience  when  and  how  to  take  it,  as  well  as 
when  to  abstain  from  it. 

In  amemic  and  atonic  cases  a  moderately  stimu- 
lating dietaiy  answers  best,  and  animal  food  and  soups, 
well  selected  and  pleasantly  flavoured  with  suitable 
condiments,  are  better  digested  than  farinaceou.s 
foods  which  have  a  tendency  to  undergo  acid  fer- 
mentation. 

The  meat  should  be  tender  and  not  overcooked. 
A  purely  milk  diet,  which  often  proves  so  beneficial 
in  cases  of  gastric  catarrh,  is  not  sufficiently  stimu- 
lating for  the  cases  we  are  now  considering. 

In  all  these  cases  individual  peculiarities  must  Ijb 
carefully  studied,  especially  as  to  the  ease  or  rapidity 
\vith  which  particular  articles  of  food  can  be  digested. 

The  coolcing  should  be  as  simple  as  possible, 
so  tliat  the  natural  flavour  of  the  food  sliould  be 
■  "  Du  Ivegimc  Aliiiieiitairc,''  p.  321. 


Chap.  II.]  Diet  in  Dyspepsia.  353 

preserved,  cand  any  agreeable  condiment  may  be 
added  in  moderation ;  all  twice-cooked  meats  should 
be  avoided. 

Green  vegetables,  unless  in  very  small  quantity, 
especially  of  the  cabbage  tribe,  should  be  eschewed, 
as  they  are  very  prone  to  give  rise  to  flatulence. 

Much  has  been  written  lately  in  Germany  and 
France  of  the  diagnostic  value  of  direct  examination 
of  the  gasti'ic  juice  in  disorders  of  digestion,  and 
various  methods  have  been  devised  for  withdrawing 
the  gastric  juice  from  the  stomach  for  this  purpose. 
The  stomach  pump,  aspiratory  tubes,  sponges  swal- 
lowed and  subsequently  withdrawn  from  the  stomach, 
and  modifications  of  these  methods,  have  all  been 
adopted  and  described  by  Leube,  Ewald,  G.  See, 
Dujardin-Beaumetz,  and  others  ;  and  much  stress  has 
been  laid  on  the  proportion  of  hydrochloric  acid  thus 
found  in  the  gastric  juice.  But  to  our  mind  it  is 
extremely  doubtful  from  the  evidence  produced 
whether  any  considerable  practical  advantage  has 
attended  this  very  troublesome  and  unpleasant  mode 
of  investigation. 

Dujardin-Beaumetz  has  pointed  out*  the  uncer- 
tainty of  the  conclusions  drawn  from  the  examination 
of  the  gastric  juice,  since  in  the  same  patient  the 
acidity  of  the  gastric  juice  will  increase  and  diminish 
under  the  influence  of  many  causes.  This  last  author, 
as  a  guide  to  the  construction  of  appropriate  dietaries 
for  the  dyspeptic,  divides  them  into  three  grou{)st  : — 

1.  Those  in  whom  the  secretion  of  gastric  juice 
is  abnormally  abundant.  For  these  he  prescribes  a 
purely  vegetable  diet :  farinaceous  substances,  fresh 
vegetables,  and  fruits.  Milk  as  a  beverage,  and  some- 
times beer,  but  never  wine. 

2.  Those  in  wliom  the  gastric  secretion  is  deficient. 
For  these  he  orders  meat  and  meat-broths ;  but  the 

*  "Sur  rExamen direct  du  Sue  Gastrique." — Acad,  de  Midecin 
24  Juin,  1888. 

t"  "L'Hygiene  Alimentaire."  "Du  Regime  spCcial  flan«  le» 
Maladies  de  TEstomac." 

X 


354  Food   m  Disease.  [Pan  ii. 

meat  should  be  reduced  to  pulp  or  powder,  and  the 
quantity  carefully  limited  to  the  digestive  capacity  of 
the  patient.  Milk  is  also  admissible,  as  it  augments 
the  digestive  power  of  the  stomach  by  the  presence  of 
lactic  acid ;  he  also  approves  of  the  addition  of  milk 
to  meat-broths.  Wine  or  weak  brandy-and-water  he 
allows,  as  calculated  to  increase  the  acidity  of  the 
gastric  juice.  Peptonised  foods  may  be  advantageous 
to  certain  individuals. 

3.  Those  dyspeptics  who  are  troubled  with  sym- 
pathetic affections,  as  giddiness  (vertige  stomacal  ot 
Trousseau).  For  this  class  he  considers  it  important 
to  lessen  the  possibility  of  any  excitement  proceeding 
from  irritation  of  the  gastric  mucous  membrane  ;  and 
to  carry  out  this  indication  he  urges  the  adoption  of 
a  purely  vegetable  dietary  composed  of  farinaceous 
foods,  fresh  vegetables  and  fruits,  permitting  milk  as 
a  beverage. 

The  following  is  a  detailed  account  of  the  veget- 
arian dietary,  the  adoption  of  which  he  considers  so 
important  in  the  case  of  many  dyspeptics  : — 

Bread. — Crust  of  bread  or  dry  toast. 

Farinaceous  Foods. — Purees  of  potatoes,  of  haricots,  and  of 

lentils ;  revalenta ;  maize  flour ;  chestnut  meal ;  oatmeal ; 

pearl  barley,  macaroni,  and  vermicelli ;  these  may  be 

taken  plain  or  with  butter. 
Fresh  Vegetables  also  in  the  form  of  purees — carrots,  turnips, 

and  the  other  vegetables  used  in  making  Julienne  soup  ; 

puree  of  green  peas,  well-cooked  salads,  spinach,  sorrel, 

French  beans. 
Fruits  should,  with  the  exception  of  grapes,  be  cooked,  and 

taken  as  compSte. 
"With  such  a  regime  he  permits  lightly -cooked  eggs,  and  he 

does  not  forbid  beer. 

Professor  G.  See  divides  dyspeptic  patients,  some- 
what arbitrarily,  into  two  groups — those  who  secrete 
too  nmch  hydrochloric  acid  {dyspepsie  hyperchlorhy- 
drique)  and  those  who  secrete  none  (dyspepsie  achlor- 
hydrique).  For  the  first  he  recommends  a  nitrogenous 
diet  and  the  avoidance  of  starchy  food ;  and  for  the 
second  he  advises  a  wholly  vegetable  diet.     To  the 


Chap.  II.]  Leube^ a  Dietaries.  355 

first  he  gives  sodium  bicarbonate  after  meals ;  to  the 
second  hydrochloi'ic  acid.* 

Professor  See  advocates  strenuously  the  value  of 
the  alkaline  (sodium  bicarbonate)  water  of  Vichy, 
taken  an  hour  or  half  an  hour  before  a  meal,  in  all 
casesf  of  dysjjepsie  chiniique. 

Leiibe,  the  celebrated  German  specialist  for 
diseases  of  the  stomach,  has  found  the  four  following 
dietaries  as  applicable  to  the  different  degrees  and 
stages  of  digestive  disorders.  No.  1  is  considered  to 
be  the  most  easy  of  digestion,  and  is  suitable,  there- 
fore, to  the  most  severe  cases  of  dyspepsia ;  No.  2,  the 
next  easiest ;  and  so  on  up  to  No.  4. 

No.  1. — Broth,  or  clear  soup  [bouillon). 

Solution  of  meat  (Leube's  special  preparation). 

Milk. 

Eggs,  raw  or  very  lightly  cooked. 

As  beverage. — Water,  either  pure  or  slightly  charged 

with  carbonic  acid  gas. 
This  diet  is  prescribed  for  cases  of  gastric  catarrh  at 
the  outsot. 

No.  2. — Boiled  calves'  brains.     Soups,  etc.,  as  in  No.  1. 
„  ,,       sweet-bread. 

„       chicken. 
„       pigeon. 
„       bread-and-milk  (pap). 

No.  3. — The  articles  in  Nos.  1  and  2,  to  which  may  be 
added : — 

Beef  (rump)  steak,  very  underdone,  and  raw  ham  (!). 

The  steak  is  to  be  thoroughly  beaten,  to  make  it 
tender,  and  the  most  tender  portions  scraped  away 
with  a  spoon,  and  roasted  quickly  in  fresh  butter. 

A  small  quantity  of  white  bread. 

No.  4. — Contains  a  variety  of  meats. 

Roast  chicken,  pigeon,  pirtridge,  venison,  under- 
done beef  (especially  cold),  veal,  macironi. 

A  small  quantity  of  wine  is  allowed  with  this  diet, 
and  also  a  very  small  quantity  of  green  vege- 
tables, salad,  and  stewed  fruit. 

*  "Des  Maladies  de  I'Estomac  jugees  par  un  nouveau  K^actif 
Chimique."-  Acad,  de  Mid.,  January,  1888. 

t  "Du  Regime  Alimentaire,"  p.  319. 

X  2 


356  Food  in  Disease.  [Pan  11. 

We  have  considered  fully  in  the  section  on 
"  Infant  Feeding"  the  precautions  needed  to  protect 
the  artificially  fed  infant  from  those  digestive  dis- 
turbances which  are  certain  to  arise  if  it  is  given 
unsuitable  food.  It  will  be  only  needful  here  to 
consider  very  briefly  the  therapeutic  aspect  of  the 
child's  diet  when  the  infant  has  become  the  subject 
of  d3'^spej)tic  troubles.  The  symptoms  of  dyspepsia  in 
infancy  are  usually  obvious  enough — after  feeding  the 
child  becomes  restless  and  fretful,  and  is  manifestly 
ill  at  ease.  It  eructates  flatus  mixed  with  food,  often 
sour-smelling  milk  curd,  or  the  stomach  contents  may 
be  rejected  by  vomiting.  It  may  scream  as  if  in 
])ain,  with  legs  drawn  up  and  sometimes  convulsive 
twitchings  of  the  muscles  of  the  mouth  and  face. 
The  occurrence  of  any  of  these  symptoms,  and  espe- 
cially if  the  child's  general  nutrition  shows  signs  of 
disturbance,  .should  lead  at  once  to  a  most  searching 
inquiry  into  its  diet.  If  the  infant  is  breast-fed,  it  is 
probable  that  it  may  be  fed  too  frequently,  or  the 
mother's  or  nurse's  milk  may  have  become  irritating 
owing  to  want  of  sutlicient  dietetic  care  on  her  part. 
This  must  be  looked  to  and,  if  needful,  corrected.  In 
the  case  of  a  wet-nurse  being  employed,  it  may  be 
that  she  is  at  a  period  of  lactation  Avhich  does  not 
coincide  with  the  age  of  the  suckling,  and  her  milk 
may  be  indigestible  from  being  too  rich  in  casein. 
The  child  should  then  be  weaned,  and  fed  on  diluted 
peptonised  milk  or  sterilised  milk,  and  attention 
given  to  all  the  details  and  expedients  we  have 
already  fully  discussed  in  the  first  portion  of  this 
work. 

If  the  child  is  being  brought  up  by  hand,  some 
error  is  proliably  being  committed  by  its  nurse — the 
milk  used  has  not  been  perfectly  fresh  or  not  steril- 
ised, or  premature  attempts  to  give  the  infant 
starchy  foods  have  been  made.  In  such  cases  see 
that  all  the  milk  is  quite  fresh  and  thoroughly  steril- 
ised, and  not  exposed  to  any  source  of  contamination. 
The  milk   may   be  judiciously  diluted  at  first  with 


Chap.  II.]  Diet  in  Coxst/pat/on.  357 

boiled  water,  to  which  a  little  lime  water  or  a  few 
grains  of  sodium  bicarbonate  may  be  added.  In 
some  cases  it  answers  well  to  use  one  of  the  malted 
foods,  with  a  very  little  added  milk — quite  small 
quantities  being  given  at  eacli  feed  —  until  tlie 
gastric  disorder  shows  signs  of  disappearing.  Dilute 
peptonised  food  may  also  be  advantageously  used. 
We  must,  however,  always  endeavour  quickly  to 
reach  the  amount  of  nutritive  constituents,  which  we 
have  previously  shown  to  be  necessai'y,  or  the  child's 
nutrition  will  sufter.  Some  medicinal  treatment  may 
at  the  same  time  be  needed  to  correct  acidity  and 
allay  spasm. 

The  dietetic  treatn)ent  of  those  morbid  conditions 
of  the  intestinal  canal  which  lead  to  chronic  con- 
stipatifiu  must  next  occupy  our  attention. 

A  want  of  tone  or  a  pai'etic  state  of  the  intestinal 
walls  is  a  not  uncommon  consequence  of  chronic 
intestinal  catarrh. 

Sedentary  habits  and  insufldcient  bodily  exercise, 
by  lessening  peristalsis  of  the  muscular  coat  of  the 
bowels,  are  well-known  causes  of  habitual  constipation. 

A  too  exclusively  nitrogenous  diet — a  diet  too 
entiiely  composed  of  easily -digested  animal  food — by 
leaving  but  little  waste  as  a  result  of  its  digestion, 
may  lead  to  constipation  from  the  absence  of  the 
stimulus  to  the  nerves  of  the  intestinal  mucous 
membrane  which  a  normal  amount  of  indigestible 
residue  produces.  Or  by  too  exciting  a  diet  and  the 
repeated  contact  of  too  stimulating  residue  the  ex- 
citability of  the  intestinal  nerves  may  be  exhausted, 
and  constipation  thus  induced.  Similarly  it  may  be 
caused  by  the  abuse  of  aperient  medicines. 

[n  dealing  with  all  such  cases,  it  is  essential 
to  make  careful  inquiry  into  the  habits  of  each 
patient  with  regard  to  the  quantity  and  nature  of 
the  food  he  takes,  so  that  we  may  make  such  correc- 
tions as  may  seem  necessary  to  overcome  the  morbid 
ha))it. 

In  some  instances  we  may  discover  that  too  dry 


358  FuoD  IN  Disease.  [Partii. 

a  diet  is  taken,  and  that  not  enough  water  is  con- 
sumed to  keep  the  contents  of  the  intestinal  canal 
in  a  fluid,  a  seini-fluid,  or  soft  condition. 

The  freer  the  supply  of  water  to  the  blood,  the 
more  fluid  tlie  intestinal  secretions  are  likely  to  be ; 
wlieieas  if  the  supply  of  fluid  to  the  blood  be  limited, 
less  fluid  is  likely  to  be  secreted  from  the  intestinal 
glands,  and  the  intestinal  mucous  membrane  will 
become  drier.  It  is,  no  doubt,  for  the  reason  here 
indicated  tliat  free  draughts  of  cold  water  taken  at 
bed-time  and  in  the  morning  fasting  will  often  succeed 
in  overcoming  habitual  constipation. 

Persons  who  lose  much  water  from  the  surface 
by  profuse  perspiration  should  also  remember  this,  if 
they  find  they  suft'er  from  constipation ;  and  that  it 
may  be,  to  some  extent,  due  to  an  abnormally  dry 
state  of  the  intestinal  mucous  membrane,  brought 
about  by  an  excessive  loss  of  fluid  from  the  skin. 

Persons  who  avoid  fresh  vegetables  and  fruit 
should  be  induced  habitually  to  add  some  of  both 
to  their  diet. 

Green  vegetables,  and  ripe  or  stewed  fruits — as 
apples,  pears,  prunes,  tigs,  etc.  —  and  the  various  kinds 
of  brown  or  wholemeal  bread,  are  well  known  to 
have  an  aperient  tendency.  This  is  due  to  the 
mechanical  irritation  which  the  undigested  residue 
of  such  foods  exerts  on  the  intestinal  mucous 
membrane. 

Four  or  five  dry  Turkey  figs,  cut  up  and  well 
soaked  in  boiling  water  and  eaten  after  dinner, 
will  often  have  a  laxative  effect. 

Eggs,  milk,  and  most  farinaceous  foods,  as  they 
leave  but  little  stinmlating  residue  from  their  diges- 
tion, tend  to  aggravate  the  constipated  habit. 

Oatmeal  and  maize  are  reputed  to  be  slightly 
aperient,  and  lioney  or  trencle  added  to  br^ad  or 
other  farinaceous  food  is  believed  to  favour  peri- 
staltic action. 

"  Bran  bread,  green  vegetables,  salads,  spinach, 
sorrel  soup  {soupe  a  I'oiselle) " — these  are  the  foods, 


Chap.  II.)  Diet  in  Diarrhcea.  359 

containing  much  indigestible  cellulose,  which  Dujardin- 
Beaumetz*  recommends  for  the  I'elief  of  habitual  con- 
stipation, to  which  he  adds  "gingerbread  {pain 
cVepice) — which,  taken  in  large  quantity,  is  very  de- 
cidedly laxative  " — grapes  in  quantity,  oranges  taken 
with  alkaline  (Vals  or  Vichy)  water,  and  linseed. 
"  Pour,"  he  says,  "  a  little  water  on  a  dessert  or  table- 
spoonful  of  linseed,  let  it  stand  for  an  hour,  and 
di'ink  the  whole  immediately  before  a  meaL" 

Spanish  or  Portugal  onions,  plainly  boiled,  will 
often  be  found  to  pi-oniote  the  action  of  the  bowels. 

In  the  opposite  condition — viz.  diarrhcea — if  of 
a  simple  character  (i.e.  not  a  complication  of  some 
other  disease),  we  have  generally  to  deal  with  it  in 
one  of  two  forms — either  as  an  acute  and  temporary 
illness,  or  a  more  or  less  chronic  malady.  The  latter 
form  is  often  intractable  and  difficult  to  remedy. 

There  is  one  general  dietetic  rule  that  applies  to 
all  cases  of  diarrhoea,  which  is  to  avoid  all  foods  that 
leave  much  undigested  residue  behind,  and  which 
may,  therefore,  tend  to  maintain  irritation  of  the  in- 
testinal mucous  membrane.  We  should  select  and 
prescribe  only  such  foods  as  leave  a  bland  and  un- 
irritating  residue  as  a  result  of  their  digestion,  and 
which  ordinarily  have  no  tendency  to  undergo  de- 
composition into  irritating  acid  substances  in  the 
alimentary  canal. 

Especially  to  be  avoided  are  green  vegetables,  raw 
acid  fruits,  nuts,  potatoes  (unless  in  the  form  of 
puret),  coarse  brown  bread,  and  all  rich,  fat,  or  acid 
dishes ;  also  all  forms  of  animal  food  which  are  hard 
or  tough  and  difficult  of  digestion,  such  as  pork, 
veal,  and  beef — unless  leduced  to  pulp  or  powder. 

Milk,  preferably  boiled,  is  usually  a  good  food  in 
diarrhcea,  unless  we  find  some  individual  peculiarity 
rendering  it  difficult  of  digestion,  and  in  such  cases 
we  must  order  unirritating  farinaceous  foods  such  as 
arrowroot,  tapioca,  sago,  rice,  etc.,  prepared  with  water 
and  flavoured  with  nutmeg,  cloves,  or  cinnamon. 
•  "  L'Hygienc  Aliuicutairo." 


360  Food  in  Disease.  ii'ait  li; 

An  acute  attack  of  diarrlicEa  wil]  often  be  rapidly 
cured  by  restricting  the  food  for  twenty-four  hours 
to  water  arrowroot,  flavoured  with  the  spices  we 
liave  just  named,  and  with  the  addition  of  two  or 
three  teaspoonfals  of  brandy,  or  a  tablespoonful  or 
two  of  port  wine,  to  each  teacupful.  Wlien  beef-tea 
or  clear  soup  is  ordered  in  these  cases,  it  should  be 
thickened  with  arrowroot,  sago,  or  tapioca. 

Soda-water  and  milk,  with  a  small  quantity  of 
brandy,  is  the  best  beverage  in  these  acute  cases ;  or 
port  wine  and  water  may  bo  substituted  when  pre- 
ferred. 

After  the  subsidence  of  the  acute  attack,  the 
return  to  the  ordinary  diet  should  be  gradual,  and 
for  a  few  days  clear  soup  or  beef-tea,  thickened  with 
the  substances  we  have  named,  boiled  chicken,  par- 
tridge, or  pheasant  with  rice,  or  boiled  whiting  or 
sole  and  a  little  mashed  potato,  should  be  the  chief 
articles  of  diet.  All  acid  wines  and  beer  must, 
during  this  period,  be  prohibited.  The  tannin  wine 
of  S.  Raphael  may,  however,  be  permitted. 

The  dietetic  treatment  of  chronic  diarrhoea  is  a 
somewhat  more  troublesome  matter.  According  to 
Dujardin-Beaumetz,*  the  four  following  means  are 
those  chiefly  to  be  relied  upon  : — 1,  Milk  ;  2,  Raw 
meat ;  3,  Peptonised  foods  ;  and  4,  Powdered  meat. 

A  strictly  milk  diet,  according  to  this  author,  if 
rigorously  followed  will  cure  all  forms  of  chronic 
diarrhoea  bul  one,  and  that  is  the  diarrhoea  of  tuber- 
culous ulceration. 

After  the  diarrhoea  has  been  overcome  by  a  strictly 
milk  diet,  he  allows  raw  meat,  but  prefers  powdered 
meat,  which  is,  however,  to  be  given  with  great  caution, 
and  increased  in  quantity  gradually  and  slowly. 

Peptonised  foods  may  also  be  tried,  and  in  some 
instances  they  may  be  found  to  agree  better  than  raw 
or  powdered  meat. 

G.  S^e  t  is  also  a  strong  advocate  of  the  use  of  raw 
*  Op.  cit. 
t  "  Du  Keginie  Alimentaire.' 


Chap.  11.]     Diet  IN  Ini-antile  DiARRiKEA.         361 

meat  in  the  treatment  of  cases  of  chronic  diarrhoea. 
He  says  the  fibres  are  "less  compact,  softer,  and  less 
irritating  "  than  meat  cooked  in  any  way ;  as  to  the 
value  of  milk  in  these  cases,  he  speaks  highly,  but 
insists  that  it  should  be  given  in  small  quantities,  and 
that  it  sliould  be  "  skimmed,  boiled,  and  diluted  with 
water,"  for  large  quantities  of  rich  milk  will,  he  main- 
tains, often  augment  diarrhoea. 

As  the  cure  becomes  established,  a  gradual  return 
to  ordinary  diet,  especially  selecting  easily  digested 
kinds  of  food,  may  be  permitted. 

In  the  diarrhoea  of  infancy,  milk  is  also  the 
proper  remedy — pure  fresh  milk  diluted  with  lime- 
water. 

It  has  been  shown  by  Hayem  *  that  the  "  green 
diarrhoea"  {diarrhde  verte)  of  infancy  is  microbic  in 
character,  and  that  it  is  necessary  to  disinfect  the 
soiled  linen  in  order  to  avoid  its  propagation  to  other 
infants.  He  recommends  the  administration  of  a  2 
per  cent,  solution  of  lactic  acid,  a  teaspoonful  to  be 
given  a  quarter  of  an  hour  after  suckling. 

The  diarrhoea  of  infants  is  certainly  often  caused 
by  insufficient  care  in  the  milk  supply.  In  hot 
weather  especially  milk  is  apt  to  undei-go  fermen- 
tative changes  very  ra])idly,  and  if  not  carefully 
preserved  from  contamination  by  microbes,  it  becomes 
a  frequent  source  of  infective  disturbance  of  the  infant's 
alimentary  tract.  The  first  duty  of  the  medical  man 
when  summoned  to  a  case  of  infantile  diarrhoea  is 
scrupulously  to  investigate  the  nature  of  the  milk 
used  for  feeding  the  child,  and  to  see  that  only 
properly  sterilised  milk,  quite  fresh,  be  used,  and 
that  the  feeding  bottles  are  also  sterilised,  f 

In  some  cases  it  may  be  necessary  to  give  up  milk 
as  a  food  for  a  time,  and  to  have  recourse  to  such 
substitutes  as  have  been  described  in  the  section  on 
infant  feeding :  such  as  bread-jelly  mixed,  perhaps, 

*  Academic  de  Mid.,  17  Mai,  1887. 

t  See  Appendix,  on  "  Milk  Sterilisation." 


362  Food  in  Disease.  [Panii. 

with  a  little  peptonised  milk.  Sometimes  Valentin's 
meat-juice,  1  part  to  20  parts  of  water,  is  useful  as  a 
temporary  expedient.  It  is  needful  sometimes,  in 
cases  of  serious  exhaustion  in  infants,  to  add  a  little 
brandy  to  the  food — from  15  to  60  drops,  according 
to  the  age  of  the  child,  every  four  hours.  In  still 
more  serious  exhaustion,  approaching  collapse,  small 
enemata  of  peptonised  beef-tea,  very  slightly  thickened 
with  arrowroot,  and  liaA'ing  a  little  brandy  mixed 
with  it,  may  be  required. 

Di\  Stange  advocat^fs  the  koumiss  cure  in  some 
cases  of  chronic  diarrhoea,  and  he  mentions  one  which 
persisted  after  an  attack  of  epidemic  dysentery,  and 
in  which  different  modes  of  treatment  had  been  tried 
for  four  years,  "  but  the  slightest  indiscretion  in  diet 
invariably  brought  on  the  diarrhoea.  Six  weeks  after 
the  commencement  of  the  koumiss  cure  he  liad  gained 
4  kilos.,  and  could  take  any  kind  of  food  with  im- 
punity."* 

*  Von    Zicmssen's    "Handbook    of    Geueral    Therapeutics," 
ToL  i. 


363 


CHAPTER  TIT 

POOD     IN     DIABETES. 

In  the  disease  known  as  diabetes  mellitus — or,  more 
commonly,  simply  as  diabetes — the  chief  and  charac- 
teristic symptom  is  one  which  points  to  a  serious 
disturbance  in  the  processes  of  food  assimilation  and 
utilisation. 

The  normal  metabolism  in  the  body  of  saccharine 
and  starchy,  and  iu  some  instances,  it  would  seem, 
even  of  albuminous,  food  is,  for  some  reason  or  other, 
disturbed,  and  the  consequence  is  that  sugar,  in  greater 
or  less  quantity,  ajjpears  iu  the  urine. 

In  a  state  of  health,  the  starchy  and  saccharine 
substances  (carbohydrates),  which  form  important 
constituents  of  our  daily  food,  undergo  complete  con- 
vei-sion  in  the  system.  The  starch  is  converted  into 
sugar,  and  this,  together  with  the  sugar  taken  as  such 
into  the  stomach,  is  wholly  appropriated  and  utilised 
in  the  body.  None,  or  pnictically  none,*  passes  out 
of  the  healthy  body  as  sugar.  In  the  disease  known 
as  diabetes  it  is  otherwise.  In  this  disease  a  more  or 
less  notable  quantity  of  sugar  escapes  in  the  urine,  and 
we  find  from  observation  that  the  amount  of  sugar 
which  appears  in  the  urine  is  usually  projxjrtioned  to 
the  amount  of  saccharine  and  starchy  substances  taken 
in  the  food.  In  the  more  serious  forms  of  this  disease 
it  is  found  that  sugar  may  be  discharged  in  the  urine, 
even  when  no  starchy  or  saccharine  substances  are 
taken  in  the  foo'l,  and  it  is,  therefore,  certain  that  in 
some  instances  of  this  disease  sugar  is  formed  within 
the  body  from  other  substances  than  the  carbohy- 
drates of  the  food  ;  that,  in  short,  nitrogenous  matter 

'  *  Pavy  maintains  that  a  minute  tjuiintity  of  sugar  can  always 
be  detected  in  the  urine,  if  we  employ  sufficiently  delicate  tcbts. 


364  Food  in  Disease.  (Partii. 

(proteids)  can  undergo  transformations  which  result 
in  the  production  of  sugar.* 

In  liealth  the  sugar  wliicli  is  taken  into,  or  formed 
within,  tlie  organism  is  doubtless  to  a  great  extent, 
directly  or  indirectly,  utilised  iu  the  production  of 
force  ;  in  diabetes  it  escapes  from  the  body  uncon- 
sumed.     This  is  the  essential  feature  of  the  disease. 

Small  amounts  of  sugar  may  occasionally  and 
tempor.irily  be  detected  in  the  urine  in  health  by  the 
ordinary  tests,  and,  according  to  Pavy,  as  much  as 
from  5  to  8  parts  in  1,000  maybe  so  formed  ;  but  this 
is  a  rare  and  temporary  incident,  and  is  usually  refer- 
able to  the  consumption  of  an  excess  of  saccharine  or 
starchy  articles  of  diet.  The  occasional  and  temporary 
presence  of  so  small  an  amount  of  sugar  in  the  urine 
has  no  serious  clinical  significance. 

The  normal  presence  of  sugar  in  the  blood  in 
health  was  established  long  ago  by  Claude  Bernard, 
and  is  now  universally  adndtted.  As  to  its  source, 
amount,  and  destination,  great  difterences  of  opinion 
exist.  C.  Bernard  (whose  name  is  associated  with  the 
remarkable  discovery  of  what  is  known  as  the 
glycogenic  function  of  the  liver)  taught  that  in  man 
and  other  mammalian  animals  the  blood  was  always 
found  to  contain  sugar,  and  that  this  was  a  normal 
physiological  condition,  j)rovided  the  sugar  did  not 
exceed  a  certain  amount.  If,  however,  the  blood  came 
to  contain  more  than  three  parts  of  sugar  in  one 
thousand,  then  sugar  appeared  in  the  urine,  and  the 
appearance  of  sugar  in  the  urine  was  a  pathological 
phenomenon. 

As  to  the  source  of  the  sugar  in  the  blood, 
0.  Bernard  maintained  that  the  liver  had  the  power 

*  "A  part  of  the  non-nitrogenous  atom-groups  of  the  large 
albumin  molecule  is  always  first  converted  into  carbohydrate  or 
caibohydrate-like  combinations  l)efore  it  is  further  burned  up  into 
C'Oj  and  H-0.  In  this  manni^r  there  is  formed  at  least  45  granmies 
of  carbohydrate  out  of  every  100  grammes  of  albumin  decomposed 
in  the  body.  In  what  part  of  the  body  this  formation  of  carbo- 
hydrate from  albumin  takes  place  is  not  clear." — Von  Xoorden  on 
Diabetes,  "  Tweutietk  Century  Practice,"  vol  ii.  p.  40, 1895. 


Chap.  III.]       Causation  OF  Glycosuria.  365 

of  transforming  the  glucose  absorbed  by  the  blood- 
vessels from  the  alimentary  canal,  and  brought  to  it 
by  the  portal  veins,  into  an  amyloid  substance  which 
he  termed  "  glycogen,"  and  this  was,  he  believed, 
subsequently  reconverted  into  glucose  and  restored 
to  the  blood. 

And  he  maintained  that  the  glucose  resulting 
from  the  digestion  of  the  starchy  and  saccharine 
principles  of  our  food  did  not  pass  directly  into  the 
general  circulation,  but  was  transformed  into  a  non- 
diffusible  colloid  substance  allied  to  starch,  namely, 
"glycogen,"  in  which  form  it  could  be  stored  up  in 
the  liver-cells,  and  thence  be  reconverted  and  added 
to  the  blood  as  it  was  needed.  According  to  this 
view,  the  liver  acts  as  a  great  regulator  of  the  glyco- 
genic function,  and  stores  up  a  quantity  of  carbo- 
hydrate substance,  by  the  regular  conversion  of 
which  into  glucose  a  fixed  and  constant  supply  of 
this  material  to  the  blood  is  provided  for,  and  not  an 
irregular  and  intermittent  one,  as  would  be  the  case 
if  the  sugar  derived  from  tho  food  were  to  pass 
directly  into  the  blood.* 

Also,  as  to  the  destination  of  the  sugar  of  the 
blood,  Bernard  taught  that  it  was  consumed  in  the 
capillaries  in  the  processes  of  nutrition  or  force-' 
formation — such  as  e.g.  the  development  of  animal 
heat — and  that  ultimately  it  was  eliminated  in  the 
form  of  carbonic  acid  and  water ;  and  that,  as  a  fact, 
there  was  considerably  less  sugar  in  venous  than  in 
arterial  blood. 

We  can  see  how,  according  to  this  theory,  gly- 
cosuria or  diabetes,  due  to  an  excess  of  sugar  in  the 
blood,  might  arise  in  three  diffi^rent  waya  First,  it 
nn'yht  be  due  to  incomplete  combustion,  to  incomplete 
nutritive  transformation  of  the  sugar  of  the  blood  in 


*  Von  Noorden  points  out  that  "glycogen  is  found  in  other 
organs  than  the  hver,  especially  in  the  muscles.  .  .  The 
iTiUscles  .  .  are  likewise  a  glycogen  depot ;  .  .  they  elab- 
orate their  own  store  of  glycogen  from  grape-sugar." — "Twen 
tieth  Ceutury  Practice,"  vol.  ii.  p.  39,  1895. 


366  Food  tn  Disease.  [Partii. 

the  caj)illaries ;  so  that  diabetes  might  bo  a  disease  of 
"retarded  nutrition,"  as  Professor  Bouchard  terms  it; 
or,  secondly,  it  might  depend  on  a  suspension  of  the 
glycogenic  function  of  the  liver,  so  that  the  sugar  pro- 
ceeding from  the  alinientaiy  canal  would  pass  directly 
into  the  general  circulation,  and  not  be  tixed  in  the 
form  of  "glycogen"  in  the  liver-cells;  or,  thirdly,  it 
might  arise  from  a  disturbed  activity  of  the  glycogenic 
function,  whereby  the  formation  and  transformation 
of  glycogen  became  excessive,  and  glucose  was 
thereby  added  to  the  blood  faster  than  it  could  be 
consumed  in  the  tissues. 

The  experimental  researches  of  Pavy  have,  how- 
ever, led  him  to  conclusions  which  differ  from  the 
foregoing.  He  admits  that  sugar  is  always  present  in 
the  blood  in  health,  but  only,  he  asserts,  in  very  small 
and  insignificant  quantity  ;  and  he  maintains  that  the 
presence  of  this  small  amount  of  sugar  in  the  blood 
coincides  with  and  is  the  cause  of  the  constant 
presence  of  a  small  amount  of  sugar  in  the  urine  ;  in 
short,  that  whenever  there  is  sugar  in  the  blood,  there 
is  a  proportionate  quantity  of  sugar  in  the  urine.  As 
to  its  source,  he  contends  that  it  simply  represents  the 
small  quantity  of  sugar  which  may  reach  the  thoracic 
duct  through  the  absorbents  from  the  alimentary 
canal  during  the  digestion  of  saccharine  and  starchy 
food  ;  and  as  to  its  destination,  that  it  is  eliminated 
by  the  kidneys.  He  maintains  that  no  combustion 
of  sugar  takes  place  in  the  capillaries,  and  that  any 
difference  between  the  amount  found  in  venous  and 
arterial  blood  is  insignificant. 

Pavy  asserts  that  it  is  the  function  of  the  liver  to 
arrest  the  passage  of  sugar  into  the  general  circu- 
lation ;  that  it  converts  the  sugar  absorbed  from  the 
alimentary  canal  into  an  amyloid  substance  (Bernard's 
glycogen),  which  becomes  fixed  in  the  liver-cells, 
where  it  undergoes  a  change  which  forms  one  of  the 
links  in  the  series  leading  up  to  the  final  issue,  namely, 
the  utilisation  of  sugar  as  a  force-producing  agent  in 
the  system. 


Chap,  111.]        Causation  OF  Glycosuria.  367 

Tlie  further  transformation  of  this  amyloid  sub- 
stance is  not  clearly  traceable,  but  Pavy  believes  it 
may  be  converted  into  fat. 

According  to  this  view,  the  liver  exercises  a 
sugar  -  detaining  and  a  sugar  -  assimilating  function 
whicli  preveiits  us  from  being  diabetic !  The  sugar 
derived,  either  directly  or  indirectly,  from  the  food 
and  absorbed  from  the  alimentary  canal,  is  stopped  by 
the  selective  or  secreting  action  of  the  liver-cells,  and 
in  these  is  transformed  into  amyloid  substance.  When 
not  so  stopped  it  reaches  the  general  circulation  and, 
as  a  result,  gives  rise  to  the  presence  of  sugar  in  the 
urine  in  proportion  to  the  amount  of  sugar  absorbed 
from  the  alimentary  canal ;  so  that  in  diabetes  the 
eliminated  sugar  stands  in  relation  to  the  amount  of 
sugar  or  sugar-forming  material  ingested ;  and  this 
universally-admitted  fact  is  the  basis  of  all  the  dietetic 
rules  which  have  been  applied  to  the  treatment  of  this 
disease. 

In  diabetes  there  is  a  failure  in  the  assimilation  of 
sugar.  It  may  be  that  the  sugar  simply  passes  un- 
influenced through  the  liver ;  or  it  may  be  converted 
into  amyloid  substance  in  the  liver,  and  rapidly  re- 
converted back  again  into  sugar.  At  any  rate,  what 
is  clear  is,  that  the  sugar  derived  from  the  ingestion 
of  food  is  not  stopped  from  reaching  the  general 
circulation,  as  it  ought  to  be ;  and  Pavy  thinks  that 
a  simple  passage  through  the  liver  is  what  occui-s, 
and  tha.t  diabetes  is  essentially  due  to  a  fault  in  the 
assimilating  or  detaining  functions  which  the  liver  in 
health  exercises  on  the  sugar  which  reaches  it  from 
the  alimentary  canal. 

"We  must  also  remember  that  in  certain  grave  forms 
of  diabetes,  even  if  proteids  only,  such  as  lean  meat, 
ai"e  consumed,  sugar  is  still  found  in  the  urine,  although 
in  greatly  diminished  quantity ;  and  in  carnivorous 
animals,  fed  only  on  lean  meats,  amyloid  material  in 
considerable  quantity  is  found  in  their  livers. 

The  diflerence  in  the  views  propounded  by  C. 
Bernard  and  those  held  by  Pavy  is  simply  as  to  the 


368  Food  in  Disease.  [Part  11. 

destination  of  the  amyloid  substance,  the  "  glycogen," 
whicli  both  admit  is  formed  in  the  liver,  and  which 
both  admit  is  exceedingly  pi-one,  as  one  of  its  chemical 
properties,  to  pass  into  sugar. 

Bernard  taught  that  the  glycogenic  function  of 
the  liver  was  to  regulate  the  su[)ply  of  sugar  to  the 
blood,  in  which  fluid  it  was  consumed  and  applied  to 
force-production  ;  Pavy  contends  that  in  health  the 
glycogen  in  the  liver  does  not  undergo  any  such  con- 
version, that  its  probable  destination  is  to  form  fat, 
and  that  the  conversion  of  sugar  into  "  glycogen  "  by 
the  liver  prevents  the  sugar  from  passing  into  the 
blood  to  any  material  extent,  and  so  saves  us  from 
being  diabetic  1 

Recently  Pavy  has  put  forward  some  additional 
views  on  the  destination  of  the  carbohydrates  of  our 
food,  which  he  thinks  justified  by  certain  experi- 
mental researches  he  has  been  making.  To  us,  we 
must  admit,  they  appear  at  present  far  from  the  stage 
of  actual  proof  and  demonstration,  and  although  to 
some  extent  the  outcome  of  experimental  observation, 
to  be  as  theoretical  as  any  that  have  been  previously 
advanced.  He  believes  that  the  lymphoid  cells  of 
the  villi  act  as  "  a  first  line  of  defence  "  against  the 
passage  into  the  blood  of  the  carbohydrates  of  the 
food,  and  that  they  "synthesise  carbohydrates  with 
nitrogeneous  matter  into  proteid,"*  and  also  convert 
carbohydrates  into  fat.  "The  villi  thus  become 
invested  with  an  importance  not  previously  known 
to  be  theirs,"  and  "  the  cells  of  the  intestinal  mucous 
membrane  are  the  seat  of  the  process  through 
which  persons  become  fat  on  a  carbohydrate  diet.  In 
the  liver  glycogen  is  formed  by  this  transmutation  of 
the  surplus  carbohydrate  of  the  food  which  escapes 
synthesis  by  the  cells  of  the  villi."  This  glycogen 
stored  in  the  liver,  he  thinks,  probably  goes  eventually 
to  the  formation  of  fat.  "  There  are  thus  two  lines 
of  defence — the  villi  and  the  liver." 

*  Croonian  Lectures  on  "A  New  Departure  in  Diabetes," 
July,  1894. 


Chap.  HI.]     Different  Forms  of  Diabetes.       369 

In  diabetes  *'  the  two  lines  of  defence  arc  less 
perfect  tliau  in  health.  ...  A  diabetic  is  a 
person  who  has  not  protoplasmic  power  sutJicient  to 
dispose  of  the  carbohydrates  in  his  diet  by  synthesis  to 
proteid,  by  transmutation  into  fat,  and  by  dehydration 
into  glycogen."  Pavy  is  thus  at  variance  with  nearly 
all  other  authorities  on  this  subject,  and  would  reject 
as  inaccurate  even  the  definition  of  diabetes  as  framed 
by  Von  Noorden,  that  it  is  ''  a  disease  in  which  the 
capacity  of  the  organism  for  burning  up  grape-sugar 
is  morbidly  depressed."* 

We  are  here,  however,  only  indirectly  concerned 
in  the  discussion  of  the  pathological  theories  that  have, 
beeu  advanced  to  account  for  the  diabetic  state  ;  our 
present  purpose  is  the  practical  one  of  determining 
the  most  suitable  kind  of  food  for  diabetics,  so  as 
to  arrest  or  check  their  glycosuria ;  the  amount  and 
persistence  of  which  may  generally  be  taken  as  an 
indication  of  the  gravity  of  the  malady. 

The  principal  rule  which  should  govern  tlie  con- 
struction of  a  dietary  for  the  diabetic  is  to  exclude 
from  it,  as  far  as  is  consistent  with  the  due  nutrition 
of  the  body,  all  those  articles  of  food  that  can  be 
converted  in  the  organism  into  sugar. 

Having  composed  such  a  diet,  and  applied  it  to  iiny 
particular  case  of  diabetes,  the  prognosis  of  that  case 
will,  in  a  great  measure,  depend  upon  what  we  oljserve 
to  be  the  result  of  that  diet ;  if  the  amount  of  sugar 
in  the  urine  diminishes  rapidly  in  quantity,  an<l  ulti- 
mately disappears,  the  prognosis  is  favourable;  if  it 
persists,  or  diminishes  but  slightly  in  quantity,  the 
prognosis  is  unfavourable. 

In  practice  we  certainly  encounter  cases  of  diabetes 
of  such  very  different  degrees  of  severity,  and  amenable 
to  treatment  in  such  very  varying  degrees,  that  many 
physicians  have  bo3n  induced  to  conclude  that  they 
are,  prol>a,bly,  examples  of  two  more  or  less  distinct 
maladies.  To  the  slighter  and  more  curable  form  of 
disease  they  have  applied  the  term  "glycosuria,"  -ind 
*  "Twentieth  Century  Pructicc,"  vol.  ii.  p.  30,  18'.)"). 
V 


37°  Food  in  Disease.  [Panii. 

to  the  graver  and,  for  the  most  part,  incurable  form, 
they  apply  the  term  "  true  diabetes." 

"  In  elderly  persons,"  says  Bristowe,  "and  especi- 
ally in  such  as  are  gouty,  the  urine  not  unfrequently 
contains  sugar.  It  may  be  in  large  quantities,  and 
yet  few  or  none  of  the  other  symptoms  of  diabetes  are 
present.  The  glycosuria  under  such  circumstances 
may  persist  for  years,  either  uniformly  or  with 
remissions ;  the  patient  perhaps  passing,  at  times, 
more  water  than  is  natural  and  suffering  more  or  less 
from  dyspepsia,  yet  pi-esenting  no  emaciation,  and 
no  serious  impairment  of  strength,  and  ultimately 
recovering,  or  dying,  not  of  diabetes  or  its  ordinary 
complications,  but  of  some  independent  disease." 

Other  physicians,  as  Dujardiii-Beaumetz,*  for  ex- 
ample, classify  cases  of  diabetes  under  three  forms  : — 

(a)  Slight  cases ; 
(6)  Cases  of  medium  intensity  ; 
(c)  Grave  cases ; 
and,  so  far  as  the  results  of  feeding  are  concerned, 
this  is  a  useful  division. 

The  adoption  of  a  suitable  diet  will  often,  in  tlie 
*■'  slight  cases,"  bring  about  a  rapid  and  remarkable 
disappearance  of  the  glycosuria.  Dujardin-Beaumetz 
states  that  he  has  seen  a  great  number  of  diabetics 
who  have  been  passing  from  1,500  to  3,000  grains  of 
sugar  per  diem,  and  after  eight  days  of  dietetic  treat- 
ment the  sugar  has  wholly  disappeai'ed.  The  slightest 
infraction  of  the  prescribed  diet  would,  however,  be 
attended  with  a  reappearance  of  sugar  in  the  urine. 

In  the  second  group  of  cases,  the  cases  of  medium 
intensity,  the  application  of  a  suitable  diet  will  lessen 
considerably  the  quantity  of  sugar  in  the  urine,  but 
will  not  cause  it  to  disappear  completely ;  from  1 50 
to  300  grains,  perhaps,  being  excreted  daily. 

These  were  termed  by  Bouchardat  petits  diabetiqties. 

It  is  in  the  treatment  of  these  two  forms  of  diar 
betes  that  the   natural   alkaline  mineral  waters,  in 

•  "  L'Hygiene  Alimentaire,"  p.  176. 


Chap.  III.]     Different  Forms  of  Diabetes.      371 

addition  to  a  suitable  dietary,  prove  of  such  remark- 
able value. 

Seegen  and  Kraus  of  Carlsbad,  and  Schmitz  of 
Neuenahr,  have  published  nuuierous  instances  of  the 
cure  of  diabetes  at  these  spas,  while  similar  evidence 
lias  been  offered  in  abundance  by  the  physicians 
practising  at  Vichy  and  Contrexeville.  Dr.  Debout- 
d'Estrees,  of  the  latter  place,  has  pointed  out  the 
frequent  co-existence  of  glycosuria  and  uric  acid 
gravel,  and  in  such  cases  he  has  observed  a  complete 
cure  of  the  glycosuria  under  the  influence  of  the 
Contrexeville  springs  ;  he  states  that  *'  stout  diabetic 
patients "  and  "  gouty  diabetic  patients "  rapidly 
lose  their  glycosuria  there. 

In  the  third  group  of  cases,  the  "  grave  "  form  of 
diabetes,  such  as  we  usually  find  presented  by  young 
persons  when  attacked  with  this  malady,  the  treat- 
ment by  diet  is  not  attended  with  such  good  results. 

These  patients  are  usually  thin,  and  tend  to 
emaciate  rapidly,  and  even  when  deprived  of  all  carbo- 
hydrates, and  restricted  to  a  purely  nitrogenous 
dietary,  they  will  still  continue  to  excrete  a  consider- 
able quantity  of  sugar  in  their  urine.  They  appear 
to  form  sugar  out  of  nitrogenous  substances,  and  to 
transform  even  their  own  muscles  into  glycogen  and 
urea. 

These  cases  usually  run  a  more  or  less  rapid 
course  to  an  inevitably  fatal  termination. 

The  marked  clinical  distinction  between  the  slight 
and  the  grave  forms  of  diabetes,  the  curability  of  the 
one  and  the  incurability  of  the  other,  seem  to  point  to 
the  probability  that  the  occunence  of  glycosuria  may- 
depend  on  two  or  more  pathological  states  not  neces- 
sarily always  associated  or  interdependent. 

First,  in  the  slighter  forms,  the  gouty  diabetics, 
the  pathological  condition  may  simply  be  one  of 
depressed  hejxUic  /unction.  The  liver  fails  to  exercise 
fully  and  completely  its  duty  in  the  convei-sion  of  the 
alimentary  glucose  into  "  glycogen,"  and  a  portion 
only  of  the  sugar  conveyed  by  the  portal  vein  to  the 
y2 


372  Food  in  Disease.  [Panii. 

liver  is  converted  into  amyloid  material,  a  consider- 
able part  being  allowed  to  pass  on  tlirougli  the  liver 
into  the  blood,  whence  it  finds  its  way  into  the  urine, 
and  is  eliminated  thereby.  With  this  we  often  find 
associated  other  evidences  of  depressed  liver  function, 
sucli  as  the  excessive  formation  of  uric  acid  and  the 
occurrence  of  obesity. 

It  is  these  cases  that  are  especially  amenable  to 
dietetic  and  other  treatment,  and  es[)ecially  to  treat- 
ment by  alkaline  waters  like  those  of  Vichy  and 
Carlsbad,  when  associated  with  an  appropriate 
dietary. 

Secondly,  in  the  severe  and  grave  form,  in  cases 
of  so  called  "  true  diabetes,"  in  which  we  find,  not 
simply  the  symptom  of  glycosuria,  but  other  still 
more  serious  symptoms  of  disturbed  nutrition,  we  may 
suppose  that  in  these  cases  there  is  a  diminution  of 
the  sugar-consuming  power  of  the  tissues.  "  The 
cells  of  the  body  may  have  lost,  in  whole  or  part,  their 
capacity  of  seizing  upon  the  sugar  molecule."  In  these 
cases  all  the  remedial  measures  we  at  present  possess 
prove  of  but  little  avail ;  and  all  we  can  hope  for  is 
to  retard  somewhat  the  progress  of  the  malady.* 

Neither  of  these  hypotheses  is  inconsistent  with 
the  occasionally  observed  occurrence  of  glycosuria 
from  irritation  of  portions  of  the  nervous  system,  as 
in  C.  Bernard's  celebrated  experiment  of  pricking  the 
floor  of  the  fourth  ventricle. 

For  the  eflect  of  such  irritation  may  be  to  disturb 
the  innervation  of  the  vessels  of  the  liver,  to  cause 
dilatation  of  these  vessels,  and  so  to  allow  the  blood 
to  be,  as  it  were,  hurried  through  this  organ  at  a  rate 
which  is  inconsistent  with  the  complete  transfor- 
mation of  the  alimentary  glucose  of  the  portal  blood 
into  the  amyloid  substance  "  glycogen,"  so  that  a 
portion  of  this  sugar,  which  should  be  detained  and 

*  Much  interest  has  recently  bc-n  felt  in  the  observation  that 
experimental  removal  of  the  pancreas  of  the  dog  causes  glycosuria, 
and  leads  to  the  production  of  a  disease  resembling  in  every  par- 
ticular grave  diabetes  in  man. 


Chap.  III.]  Diet  in  Diabetes.  373 

fixed  in  the  liver-celLs,  flows  on  into  the  general 
circulation,  and  is  excreted  in  the  urine. 

Let  us  now  pass  on  to  the  practical  consideration 
of  what  is  the  best  dietetic  treatment  that  we  can 
apply  to  cases  of  diabetes. 

In  the  ease  of  the  fat,  well-nourished,  gouty, 
glycosuric  patient,  we  may  apply  unhesitatingly  the 
strictest  dietetic  rules,  and  commonly  with  consider- 
able success  ;  but  with  the  wasted,  ill-nourished,  true 
diabetic  the  case  is  otherwise,  and  our  difficulties  in 
the  matter  of  diet  are  great ;  for  not  oiJy  have  we  to 
consider  how  to  check  or  arrest  the  amount  of  sugar 
that  he  forms  and  excretes,  but  we  have  to  attempt 
the  even  move  difficult  task  of  maintaining  and  im- 
proving the  seriously  damaged  general  nutrition. 

It  is  generally  admitted  that  the  carhohydrates — 
i.e.  all  food-stuffs  containing  glucose,  or  whatever  can 
be  converted  into  glucose  in  the  organism — should 
be,  so  far  as  is  possible,  excluded  from  the  diet  of 
diabetics,  and  that  they  should  be  fed  as  exclusively 
as  possible  on  albuminous  foods  and  fat. 

"  In  diabetes  mellitus  the  sugar  introduced  with 
the  food  or  formed  within  the  organism  is  only  im- 
perfectly applied  in  the  animal  economy,  since  a 
greater  or  less  proportion  of  it  is  washed  out  of  the 
body  with  the  urine,  without  having  undergone  the 
normal  splitting  up.  The  sugar  and  the  sugar-forming 
substance  must,  therefore,  present  in  the  body  of  the 
diabetic  the  character  of  useless  ballast."*  Clinical 
observation  also  shows  that  the  amount  of  sugar 
excreted  in  the  urine,  so  far  as  it  is  dependent  on  the 
diet,  exercises  a  great  influence  on  the  patient's  well- 
being. 

The  fearful  thirst  of  the  diabetic  patient  is  deter- 
mined by  the  amount  of  sugar  in  the  blood,  and  we 
can  only  hope  to  relieve  the  former  by  a  diet  which 
will  also  tend  to  diminish  the  latter  ;  and  although  it 
is  true,  as  has  been  stated,  that  in  severe  cases  sugar 

*  Bauer,  "  Dietary  of  the  Sick  ; "  Von  Ziemssen's  "  Handbook 
of  General  Therapeutics,"  voL  i. 


374  Food  in  Disease.  [Pan  il 

will  still  appear  in  the  uiine,  notwithstanding  the 
entire  withdrawal  of  carbohydrates  from  the  food, 
yet  it  does  so  in  diminished  quantity,  and  this  result  is 
so  far  a  gain. 

It  would  seem  from  the  observations  of  Kiilz  * 
that  all  the  carbohydrates  do  not  increase  the  secre- 
tion of  sugar,  and  that  it  may  be  possible,  as  sug- 
gested by  Bauer,  to  utilise  some  of  them  in  relieving 
the  dread  monotony  of  the  diabetic  diet ;  and  he 
/States,  on  the  autliority  of  Kiilz,  that  mannite,  fruit- 
sugar  (levulose),  inulin,  and  inosite  have  no  effect  in 
increasing  the  sugar  in  the  urine.  It  is  very  possible 
that  not  quite  enough  attention  has  been  paid  to  the 
individual  peculiarities  of  diabetics  in  framing  their 
dietaries,  and  that  certain  carbohydrates  may  be  well 
tolerated  by  some  and  not  by  others. 

Fothei'gilljt  who,  as  is  well  known,  was  himself  a 
diabetic,  calls  attention  to  this  point,  and  he  asks  : 
"  Are  not  sometimes  slight  divergencies  from  the  rule 
permissible?  Though  milk  does  contain  sugar,  is  it 
always  advantageous  to  bar  it?  .  .  .  Sometimes 
milk  may  be  allowed  freely,  and  the  same  may  be 
said  about  ordinary  bread ; "  and  he  mentions  the 
case  of  a  glycosuric  patient  who  passed  urine  "  abso- 
lutely free  from  sugar,  yet  at  that  time  she  was 
living  upon  vermicelli  pudding  and  arrowroot ;  "  and 
he  mentions  another  instance,  that  of  a  glycosuric 
physician  who  mended  greatly  on  "  raspberry  jam." 

Kiilz  suggests  that  biscuits  might  be  made  of 
inulin,  and  he  gives  a  recipe  for  making  them ;  J  he 

*  Quoted  by  Bauer  in  "  Dietary  of  the  Sick,"  p.  296. 

t  "  Manual  of  Dietetics." 

X  "  rifty  grammes  of  inulin  are  to  be  put  in  a  large  porcelain 
basin,  and  while  standing  over  a  water-bath  to  be  rubbed  up  with 
30  c.cms.  of  milk,  and  as  much  hot  water  as  may  be  necessary, 
into  a  uniform  dough,  with  which  tire  yolks  of  four  eggs  and  a  little 
salt  are  to  be  mixed.  To  this  the  whites  of  the  four  eggs  are  to  be 
added,  having  first  been  beaten  to  a  foam  and  carefully  worked  in. 
The  dough  is  finally  to  be  baked  in  tin  moulds,  previously  smeared 
with  butter.  The  taste  of  the  biscuits  may  be  improved  by  the 
addition  of  vanilla  or  other  spices." — *'  Dietary  of  the  Sick  ;  Von 
Ziemssen's  "  Handbook  of  Oeneral  Therapeutics." 


Chap.  III.]  Diet  in  Diabetes.  375 

also  suggests  that  Lichenin,  or  "  moss  starch,"  a 
principal  constituent  of  Iceland  moss,  might  possibly 
be  suitable  for  making  diabetic  bread,  as  the  Ice- 
landers make  a  palatable  bread  from  the  meal  of 
this  lichen,  after  washing  the  bitter  principles  out 
of  it. 

He  also  found  a  great  difference  in  the  tolerance 
of  milk-sugar  by  different  diabetics  ;  some  bore  it 
remarkably  well,  while  in  others  it  caused  a  con- 
siderable increase  in  the  amount  of  sugar  in  the 
urine. 

The  inability  of  the  diabetic  to  utilise  the  carbo- 
hydrates, which  form  so  large  a  proportion  of  the 
ordinary  mixed  dietary  of  the  healthy,  makes  it 
necessary,  if  his  nutrition  is  to  be  maintained,  to 
replace  these  by  an  equivalent  amount  of  other  food- 
stuffs ;  and  in  severe  cases  a  portion  even  of  these  is 
wasted  and  excreted  in  the  form  of  sugar ;  so  that  it 
becomes  an  exceeding  difficult  problem,  in  dealing 
with  the  severe  forms  of  this  disease,  to  supply  the 
patient  with  enough  readily  digestible  food  to  com- 
pensate for  the  abnormal  waste,  as  well  as  to  maintain 
the  normal  nutrition  of  the  body.  These  considera- 
tions amply  account  for  the  craving  for  food  which 
the  majority  of  diabetics  experience. 

It  has  been  noticed  by  many  that  diabetics,  espe- 
cially in  advanced  stages,  excrete  a  large  amount  of 
urea — two  or  three  times  as  much  in  some  cases  as 
persons  in  health  ;  and  it  would  appear  that  in  this 
disease  the  metabolism  of  the  albuminates  differs 
also  from  the  normal.  According  to  Senator,  it 
is  only  in  the  severer  cases  that  there  is  increased 
destruction  of  the  albumen  of  the  organism  ;  while 
in  other  cases,  fed  on  an  exclusively  animal  diet 
and  excreting  no  sugar,  the  abnormally  large  elim- 
ination of  urea  is  accounted  for  by  the  increased 
consumption  of  albuminous  food  and  the  large  flow 
of  urine. 

But  the  chief  principle  to  be  kept  in  view  in 
determining  the  dietary  of  the  diabetic  is  this :  that 


376  Food  in  Disease.  [Panii. 

l)v  an  exclusively  animal  diet  the  excretion  of  sugar, 
in  slight  cases,  may  Vje  entirely  suspended,  and  even 
in  severe  and  advanced  cases  kept  at  a  lower  figure. 
8j>eaking  genei-ally,  albuminates  and  fats  should  form 
as  far  as  possible  the  sole  food  of  the  diabetic  ;  and 
the  severer  the  case  the  more  rigid  should  be  the  appli- 
cation of  this  rule.  Some  concessions  will,  however, 
have  to  be  made  to  the  feelings  and  wishes,  and  even 
occasionally  to  the  actual  well-being,  of  the  patient. 
And  it  would  seem  from  some  of  Kiilz's  experiments, 
that  the  power  of  utilising  sugar  in  the  system  is  not 
whoUy  lost  in  this  disease ;  and  he  has  stated  that 
some  of  his  patients  were  able,  even  in  advanced 
stages  of  the  disease,  to  metabolise  large  quantities  of 
sugar  ;  and  he  also  ascertained  that  muscular  exercise 
greatly  increased  the  metabolism  of  sugar  in .  the 
organism  of  the  diabetic,  and  lessened  its  excretion 
to  a  corresponding  extent.*  Other  observers  have, 
on  the  other  hand,  noticed  that  in  the  grave 
forms  of  diabetes,  muscular  exercise  has  been  badly 
borne. 

Besides,  hovvever,  the  objections  which  diabetic 
patients  themselves  make  to  a  diet  composed  ex- 
clusively of  meat  and  fats,  it  is  highly  probable  that 
such  an  exclusive  diet  may  be  itself  injurious  to  some 
of  them.  It  certainly  tends  to  aggravate  the  tendency 
observed  in  many  di  ibetics  to  an  increased  excretion 
of  the  nitrogenous  elements  of  the  urine,  and  especi- 
ally to  the  formation  of  uric-acid  deposits  to  which 
some  of  them  are  prone.  It  has  also  been  stated  by 
Ebstein  and  others  that  an  exclusively  animal  (meat) 
dietary  favours  the  development  of  acetone  in  the 
blood. 

In  order  to  test  the  ability  of  cases  of  mild 
glycosuria  to  metabolise  certain  quantities  of  carbo- 
hydrates Von  Noorden  adopts  the  following  plan.f 
He  starts  with  a  fixed  "standard  diet"  (the  carbo- 

•  Bauer,  p.  302. 

t  "Twentipth  Century  Practice,"  voL  ii.  p.  76,  1895. 


Chap.  III.]        FON^   I^OORDEN\s    STANDARD    DiET.       377 

hydrates,  in  the  patient's  food  having  been  previously 
gradually  reduced),  consisting  of — 

Breakfast. — 5  grms.  of  tea,  infused  in  200  o.cms.  of  water ; 
150  grms.  of  ham  ;  1  Ggg. 

Lunch.  —200  grms.  of  cold  roast  beef ;  60  grms.  of 
cucumber,  with  5  grms.  of  vinegar,  10  of  olive  oil,  with  salt 
and  pej)  i>r  to  taste;  400  c.cms.  of  ApoUinaris  water,  with 
20  c.cms.  of  brandy  ;  coffee  without  milk  or  sugar. 

Linner. — 300  c.cms.  of  clear  bouillon;  250  grms.  of  beef 
(weighed  raw),  basted  with  10  grms.  of  butter;  80  gi-ms.  of 
green  salad,  with  10  of  vinegar,  20  of  olive  oil ;  or  3  table- 
spoonfuls  of  well-cooked  green  vegcttibles ;  3  sardines  a  Vhuile  ; 
400  c.cms.  of  ApoUinaris  with  20  c.cms.  of  brandy. 

Supper. — 2  eggs  (raw  or  cooked) ;  400  c.cms.  of  seltzer 
water. 

This  is  a  diet  free  from  carbohydrates,  containing 
about  204  grms.  of  albumin  (32  grms.  nitrogen)  and 
about  135  grms.  of  fat. 

This  diet  is  prescribed  until  the  urine  is  found  free 
from  sugar  for  two  or  three  days.  Then  gradually- 
increasing  amounts  of  starch  (white  bread  or  Albert 
biscuits),  up  to  20,  50,  and  100  grms.,  are  added.  As 
soon  as,  with  the.se  increasing  additions  of  starch, 
sugar  reappears  in  the  urine,  the  following  formula  is 
obtained :  — 

Tolerance  of  starch  =  standard  diet  -f-   x  grs.  of  starch. 

By  this  means  it  will  be  found  that  in  patients 
with  mild  glycosuria  the  diabetic  disturbance  is  not 
constantly  the  same  in  a  given  case — that  it  oscil- 
lates remarkably,  quite  independently  of  any  thera- 
peutic  interference —so  that  at  times  they  are 
enabled  to  take  considerable  quantities  of  carbo- 
hydrates without  passing  any  sugar  in  the  urine  : 
this  is  esi>ecially  noticeable  in  corpulent  and  gouty 
persons.  This  standard  diet  can  also  be  applied  to  the 
estimation  of  severe  forms  of  glycosuria  ;  not,  of  course, 
with  the  idea  of  adding  carbohydrates  to  it,  but  for 
the  purpose  of  testing  to  svhat  extent  albuminous 
food  can  be  metabolised  without  the  appearance  of 
sugar  in  the  urine. 


378  Food  in  Disease.  [Partii. 

The  greater  the  amount  of  sugar  found  in  the 
urine  after  the  institution  of  this  diet,  the  graver  is  the 
glycosuria.  "  If  such  trials  are  repeated  from  time  to 
time,  it  will  be  found  that  in  these  severe  forms,  as 
well  as  in  the  milder  ones,  the  sugar-destroying  power 
varies  in  energy  in  individual  cases.  Cases  will 
frequently  be  encountered  in  which  sugar  disappears 
from  the  urine  immediately  upon  the  institution  of 
the  standard  diet,  but  which  respond  at  once  to  any 
addition  of  carbohydrates,  although  they  bear  very 
well  an  increase  in  the  amount  of  albumin.  These 
cases  are  more  favourable  than  those  in  which  sugar 
continues  to  be  excreted,  even  with  the  standard  diet, 
but  are  less  favourable  than  those  which  cjm  bear  a 
slight  addition  of  carbohydrates  to  this  standard  diet." 

Some  years  ago  it  was  stated  by  Dr.  Scott  Donkin 
that  he  had  obtained  excellent  results  in  the  treat- 
ment of  diabetes  by  an  exclusively  milk  diet.  His 
system  was  to  limit  the  food  to  skimmed  milk,  of  which 
the  patient  was  ordered  to  consume  at  first  four  to 
six  pints  a  day,  which  quantity  was  slowly  increased 
to  twelve  pints.  The  milk  was  taken  waim,  and  a  por- 
tion of  it — about  one-third — was  converted  into  curds 
and  whey ;  and  Donkin  maintained  that  at  the  end  of 
a  fortnight  the  sugar  entirely  disappeared  from  the 
urine.  Although  this  method  was  never  largely 
adopted,  and  although  it  was  found  to  be  badly  borne 
by  many  diabetics,  yet  there  can  be  little  doubt  that 
it  agreed  well  with  a  few. 

Many  physicians  (Bouchardat,  Germain  S^e, 
Dujardin-Beaumetz)  discard  milk  entirely  from  the 
diet  of  diabetics. 

See  says  :  "  I  consider  milk  to  be  counter-indicated 
at  all  periods  of  the  disease,  and,  like  Frerichs,  I  have 
always  seen  the  sugar  in  the  urine  greatly  augmented 
under  its  influence."* 

Dujardin-Beaumetz  testifies  to  the  same  effect : 
*'  I   reject,"   he   observes,   "  milk    entirely  from    the 
dietary   of   the   diabetics.     I   have   always   seen   in 
*  "Da  B^gime  Alimentaire,"  p.  522. 


Chap.  III.] 


Milk  in  Diabetes. 


379 


diabetics  who  have  drunk  milk  the  amount  of  sugar 
in  their  urine  increased  by  it."  * 

There  are,  however,  other  physicians  who  have 
not  found  milk  so  injurious  to  all  their  diabetic 
patients.  Bauer  considers  it  may  be  permitted,  but 
only  in  moderation  ;  and  he  refers  to  the  remarkably 
diverse  results  of  Kiilz's  observations,  who  found  that 
in  some  of  his  diabetic  patients  milk-sugar  caused  a 
"  relatively  considerable  increase "  of  sugar  in  the 
urine;  while  in  others  it  was  "borne  surprisingly 
well."t  Von  Noorden  also,  as  we  shall  see,  makes 
free  use  of  milk  in  some  cases. 

Sir  William  Roberts  considers  milk  much  less 
deleterious  to  diabetic  patients  than  might  have  been 
supposed ;  but,  he  admits,  it  is  better  to  replace  it  by 
cream. 

Ho  made  the  following  trial  in  a  girl  with  con- 
firmed diabetes.  For  four  weeks  she  was  fed  on 
animal  flesh  and  bran  cakes  ;  for  the  next  four  weeks 
she  had  three  pints  of  milk  added  to  her  daily  diet, 
and  for  the  next  three  weeks  she  had  no  milk. 

The  followinor  table  shows  the  result : — 


Average 

qunntity 

of  Urine 

Diily. 

Average 
quantity 
of  Sugar 
Excreted 
Daily. 

Increase 
of  Weight 

Meat  Diet  and  Bran  Cakes,  for  ) 
4  weeks           j 

oz. 
56 

grains. 
897 

5 

Meat  Diet,  Bran  Cakes,  and  3  \ 
pints  of  Milk,  for  4  weeks   ...  j 

49 

1,260 

5 

Meat  Diet,  Gluten  Bread,  and  \ 
Cabbage,  for  3  weeks            . . .  ) 

41 

1,020 

7 

•  "L'Hygiene  Alimeataire,"  p.  178. 
t  Bauer,  "Dietary  of  the  Sick,"  p.  296. 


3<*^'o  Food  ik  Disease  (Part  ii. 

"  The  patient,"'  Sir  W.  Roberts  says,  "  continued 
to  f^ain  weight,  and  to  improve  in  her  general  con- 
dition under  the  use  of  milk,  altiiough  the  density  of 
the  urine  and  tlie  excretion  of  sugar  somewhat  in- 
creased. A  limited  supply  of  milk  may  therefore  he 
allowed."* 

It  has  been  found  (Von  Noorden)  that  if  equal 
weights  of  different  kinds  of  carbohydrates  are  given 
in  succes.sion,  the  diet  in  other  respects  being  the 
same,  that  grape-sugar  (dextrose,  glucose)  raises  the 
J  percentage  of  sugar  in  tlie  urine  to  the  highest  [)oint 

most  fjuickly.  Starch  and  other  carbohydrates  (such 
as  maltose  and  dextrin)  approach  grape-sugar  very 
closely  in  this  respect.  Fruit-sugar  (levulose)  in- 
creases the  glycosuria  to  only  half  the  extent,  or  even 
less  than  grape-sugar  does.  Milk-sugar  and  cane- 
sugar  occupy  a  middle  place  in  their  glycosuric  action 
between  grape-sugar  and  levulose. 

There  are,  as  might  be  imagined,  great  practical 
difficulties  in  constructing  a  satisfactory  dietary  for 
diabetics  exclusively  of  albuminates  and  fat;  indeed, 
the  quantity  of  fat  necessary  to  supply  the  requi.site 
amount  of  carbon  needed  in  the  system  is  witli  diffi- 
culty appropriated  by  the  organs  of  digestion  ;  and  to 
attempt  to  meet  the  demand  for  carbon  by  albumin- 
ates alone  would  necessitate  a  quantity  of  such  foods 
altogether  unmanageable. 

We  are,  then,  in  the  end,  driven  to  adopt  a  mixed 
diet,  the  different  articles  of  which  have  to  be  selected 
with  especial  regard  to  the  amount  of  sugar-forming 
material  they  contain,  choosing,  of  course,  tliose  which 
contain  the  minimum,  and  always  looking  to  the 
albuminates  and  fats  as  the  chief  nutritive  elements 
of  the  dietary. 

And,  first,  with  regard  to  bread.  This  forms  so 
important  an  article  in  the  habitual  daily  dietary  of 
the  healthy,  and  the  ordinary  kinds  of  bread  are  so 
rich  in  carbohydrates,  that  the  ingenuity  of  physician.s 

*  "A  Practical  Treatise  on  Urinary  and    Renal   Diseases." 
(Fourth  edition.) 


Chap.  III.]  Bread  for  Diabetics.  381 

has  been  greatly  taxed  to  produce  a  bread  for  the 
diabetic  which  shall  prove  a  satisfactory  substitute 
for  ordinary  bread. 

Bouchaidat  suggested  gluten  bread  as  a  suitable 
food  for  the  diabetic  ;  this  is  a  bread  made  of  wheat 
flour,  deprived  by  repeated  washings  of  as  much  of 
its  starch  as  pos.sible. 

But  gluten  bread  is  never  entirely  free  from 
starch,  and,  unless  it  is  prepared  with  great  care  and 
by  known  niauufactuieis,  may  even  contain  a  con- 
siderable qiiiintity.  It  is  also  by  no  means  agreeable 
to  the  palate  ;  yet,  when  well  and  carefully  prepared, 
it  undoubtedly  su|)plies  a  need. 

Sir  William  Iloberts  speaks  highly  of  a  gluten 
bread  made  in  the  form  of  small,  palatable  buns  by 
Bonthron,  lOG,  Regent  Street,  London.  They  keep 
about  a  fortnight,  and  he  found  them  nearly  free 
from  starch. 

Gluten  meal  may  be  used  for  thickening  broths 
and  for  making  puddings. 

Bran  bread,  introduced  by  Prout,  made  from  bi'an 
washed  as  free  from  starch  as  possible,  has  also  been 
largely  used  for  diabetics;  but,  unless  veiy  carefully 
prepai'ed,  it  contains  a  considerable  amount  of  starchy 
material  and  also  a  large  proportion  of  indigestible 
cellulose,  which  with  some  persons  sets  up  a  great 
deal  of  gastro-intestinal  irritation. 
.  .  Dr.  Camplin's  formula  for  bran  cakes  is  one  of  the 
y^est ;  it  is  as  follows  : — 

"  Take  a  sufficient  quantity  (say,  a  quart)  of  wheat- 
bran  ;  boil  it  in  two  successive  waters  for  a  quarter  of 
an  hour,  each  time  straining  it  through  a  sieve  ;  then 
wash  it  well  with  cold  water  (on  the  sieve)  until  the 
water  runs  off  perfectly  clear ;  squeeze  the  bran  in  a 
cL)th  as  dry  as  you  can,  then  s{)read  it  thiidy  on  a 
dish  and  place  it  in  a  slow  oven  ;  if  put  in  at  night, 
let  it  remain  until  the  morning,  when,  if  perfectly  tiry 
and  crisp,  it  will  be  tit  for  grinding.  The  bran  thus 
piepared  must  be  ground  in  a  fine  mill,  and  sil'tf^d 
through  a  wire  sieve  of  such  fineness  as  to  rc(juire  the 


382  Food  in  Disease.  [Partii. 

use  of  a  brush  to  pass  it  through  ;  that  which  remains 
in  the  sieve  must  be  ground  again  until  it  becomes 
quite  soft  and  fine.  Take  of  this  bran  powder  3  oz. 
(some  patients  use  4  oz.),  the  other  ingredients  as 
follows: — 3  new-laid  eggs,  1^  oz.  (or  2  oz.,  if  desired) 
of  butter,  and  about  \  pint  of  milk ;  mix  the  eggs 
with  a  little  of  the  milk,  and  warm  the  butter  with 
the  other  portion ;  then  stir  the  whole  well  together, 
adding  a  little  nutmeg  or  ginger,  or  any  other 
agreeable  spice.  Bake  in  small  tins  (patty-pans), 
which  must  be  well  buttered,  in  a  ratlier  quick  oven 
for  about  half  an  hour.  The  cakes,  when  baked, 
should  be  a  little  thicker  than  a  captain's  biscuit ; 
they  may  be  eaten  with  meat  or  clieese  at  breakfast, 
dinner,  or  supper;  at  tea  they  require  rather  a  free 
allowance  of  butter,  or  may  be  eaten  with  curd  or 
any  of  the  soft  cheeses. 

"  It  is  important  that  the  above  directions  as  to 
washing  and  drying  the  bran  should  be  exactly  fol- 
lowed, in  order  that  it  may  be  freed  from  starch,  and 
rendered  more  friable.  Tlie  bran  in  its  common  state 
is  soft,  and  not  easily  reducible  to  fine  powder.  In 
some  seasons  of  the  year,  or  if  the  cake  has  not  been 
well  prepai-ed,  it  changes  more  rapidly  than  is  con- 
venient. This  may  be  prevented  by  placing  the  cake 
before  the  fire  for  five  or  ten  minutes  every  day." 
These  cakes  ai'e  made  by  Blatchley,  167,  Oxford 
Street,  London.  Sir  William  Roberts  suggests  the  use 
of  seven  eggs,  instead  of  three,  as  an  improvement;  also 
the  addition  of  a  teaspoonful  of  sodium  bicarbonate. 

"  Torrified  "  bread,  made  by  toasting  thin  slices  of 
ordinary  bread  before  the  fire  until  they  are  deeply 
and  thoroughly  browned — almost  blackened — so  that 
the  starch  and  gluten  are  in  great  part  destroyed  by 
the  heat,  is  a  highly  acceptable  form  of  food  to  some 
diabetics. 

Pavy  introduced  almond  cakes  as  a  substitute  for 
ordinary  bread,  and  it  is  undoubtedly  a  valuable  one. 
By  washing  the  meal  of  sweet  almonds  with  acidulated 
water,  the  greater  pert  of  the  sugar  is  removed,  and 


Chap.  111.]  Bread  for  Diabetics.  383 

the  meal  so  treated  may  by  careful  preparation  be 
made  into  a  palatable  cake  or  biscuit. 

Seegen  also  advocates  the  use  of  almond  cakes, 
and  gives  the  following  recipe  for  making  them  : — 

Take  of  blanched  sweet  almonds  \  lb.,  beat  them 
as  fine  as  j)ossible  in  a  stone  mortar;  remove  the  sugar 
contained  in  this  meal  by  putting  it  into  a  linen  bag 
and  steeping  it  for  a  quarter  of  an  hour  in  boiling 
■water  acidulated  with  vinegar  ;  mix  this  paste 
tlioroughly  with  3  oz.  of  butter  and  two  eggs.  Next 
add  the  yolks  of  three  eggs  and  a  little  salt,  and  stir 
well  for  some  time.  Whip  up  the  whites  of  these 
eggs  and  stir  in.  Put  the  dough  thus  obtained  iuto 
greased  moulds,  and  dry  by  a  slow  fire.  Almond 
cakes  are  not  popular  with  the  French  authorities. 
G.  See  prefers  a  small  quantity  of  ordinary  bread 
— 5  oz.  daily — or  the  same  quantity  of  potato-meal. 

Dujardin-Beaumetz  also  objects  both  to  gluten 
bread  and  to  almond  cakes  ;  the  former  he  maintains 
is  often  found  to  contain  a  considerable  percentage  of 
starch ;  and  he  warmly  advocates  the  use  of  potatoes 
instead,  for  those  diabetics  who  cannot  do  without 
some  food  of  this  kind.  Potatoes  cooked  in  the  oven 
contain,  he  asserts,  only  8 "3  per  cent,  of  sugar- forming 
material,  while  gluten  bread  contains  27  per  cent. 
These  figures,  of  course,  apply  only  to  the  gluten 
bread  prepared  in  Paris.  We  must  also  remember 
that  potatoes  have  no  claim  to  be  considered  as  at  all 
approaching  gluten  bread  in  nou7'ishia(j  jjroperties,  as 
they  only  contain  2*8  per  cent,  of  albuminates. 

Dujardin-Beaumetz  advocated  the  use  of  "soya" 
bread  for  diabetics,  of  which  he  gives  the  following 
as  the  composition  : — 


Soya  Buead. 

"Water         

Proteids      

Fats 

Starch  and  Sugar 

...     45-000 
...     20-168 
...       9-350 
...       2-794 

Phosphoric  Acid 

0-863 

384  Food  in  Disease.  [Panii. 

This  bread,  he  states,  keeps  well,  and  has  an 
agreeable  taste,  and  contains  much  less  sugar-forming 
material  than  gluten  bread,  the  best  kind  of  which,  he 
asserts,  contains  at  least  16  per  cent,  of  starch  and 
saccharine  substances. 

Lecerf  *  was  one  of  the  tirst  to  call  attention  to 
the  value  of  the  meal  of  the  Soya  hispida  in  dietetics. 
It  has  a  leguminous  fruit,  like  the  haricot,  and  is  a 
native  of  China  and  Japan,  but  is  now  cultivated  in 
Austria.  The  Chinese  extract  from  soya  a  fatty  sub- 
stance which  they  use  as  milk,  and  even  make  cheese 
with  it.  The  meal  is  very  rich  in  nitrogenous  sub- 
.stances,  more  so  than  animal  flesh,  and  the  amount  of 
starchy  and  saccharine  substance  is  very  small. 

Professor  Attfield  gives  the  following  analysis  of 
the  Soya  bean  Jiour  : — 


Proteids 

Fats 

Carbohydrates 
Phosphates  ... 
Other  Salts  . . . 
Moisture       ... 


41-24 

13-70 

30-35 

4-81 

0-52 

9-38 

100-00 


Van  Abbott  prepares  both  bread  and  biscuits  of 
this  flour.  Some  patients  greatly  object  to  the 
taste. 

All  kinds  of  animal  flesli  and  fats  are  permitted 
to  the  diabetic  (except  liver),  and  all  kinds  of 
fresh  and  preserved  meat,  provided  that  sugar  has 
not  been  used  in  their  preservation — ham,  bacon, 
sausages,  fowl,  game,  fish,  fresh  and  smoked,  Crustacea 
(crabs,  lobsters,  etc.),  oysters.  Eggs,  cheese,  butter, 
cream,  and  all  animal  fats  and  oils,  cod-liver  oil, 
olive  oil,  may  also  be  partaken  by  them. 

"  Fat  is  an  invaluable  nutrient  material  to  the 
diabetic ;  it  is  his  sheet-anchor.  This  is  owing,  in  the 
first  place,  to  its  high  nutritive  value,  and,  secondly, 

•  Jourtud  de  Medecine  Pratique,  10  Jain,  1888,  ji.  0-23. 


Chap.  III.]  Diet  of  Diabetics.  385 

to  the   fact   that   its   ingestion  never  increases  the 
glycosuria."     (Von  Noorden.) 

In  cooking  any  of  the  above,  as  e.g.  fish,  it  must 
be  remembered  that  no  flour  or  other  starchy  material 
may  be  used,  or  in  the  preparation  of  sauces ;  and 
when  "  melted  butter  "  is  used  as  a  sauce  it  must  not 
be  thickened  with  flour. 

As  one  great  object  in  the  diet  of  the  diabetic  is 
to  supply  the  deficiency  of  carbon — owing  to  the 
exclusion  of  the  ordinary  carbo-hydrates — by  an  in- 
creased consumption  of  fats,  we  may  make  free  use  of 
such  articles  of  diet  as  pdte  de-foie-gras,  sardines  in  oil, 
thon  in  oil,  filets  d'hareng  saure  d,  la  Norv^gienne ; 
and  Dujardin-Beaumetz  extolled  the  use  of  caviare, 
because  it  excited  appetite,  and  he  stated  he  had 
patients  in  the  last  stage  of  diabetes  who  owed  their 
resurrection  to  the  use  of  caviare. 

Green  and  fresh  vegetables  are  freely  allowed,  and 
should  enter  as  much  as  possible  into  the  dietary  of 
the  diabetic — cabbage,  spinach,  sorrel,  lettuce,  dande- 
lion, cucumber,  watercresses,  and  those  other  vegetables 
commonly  used  for  salads  ;  and  some  physicians  allow 
a  small  quantity  of  such  vegetables  as  green  French 
beans,  asparagus,  celery,  onions,  leeks,  and  even 
carrots  and  truffles. 

Carrots,  turnips,  beans,  peas,  and  beet-root  are, 
however,  most  commonly  prohibited. 

Fruits  are  altogether  prohibited  by  some,  and  not 
so  entirely  by  others.  All  agree  in  forbidding  the 
sweeter  kinds  of  fruits,  and  all  candied  and  preserved 
fruits.  But  many  authorities  consider  a  moderate 
amount  of  fresh  acidulous  fruits  permissible — goose- 
berries, apples,  currants,  cherries,  etc.  j  they  contain 
more  levulose  than  grape-sugar. 

All  vegetables  and  fruits  containing  large  amounts 
of  starch  and  sugar  must  be  strictly  forbidden. 

The  question  of  beverage  is  a  very  serious  one  to 
the  diabetic,  for  his  thirst  is,  as  a  rule,  urgent  and 
constant,  and  his  temptation,  therefore,  to  drink  when 
and  what  he  ought  not  to,  is  very  great. 
z 


386  Food  in  Disease.  [Partii. 

All  strong  alcoliolic  drinks  must  be  forbidden, 
except  in  very  small  quantities,  and  largely  diluted 
with  water  or  an  alkaline  mineral  water. 

A  small  quantity  of  the  lighter  acid  wines,  such  as 
claret,  hock,  and  still  Moselle,  may  be  allowed,  mixed 
with  water.  Unsweetened  spirits — brandy,  gin,  and 
whisky,  mixed  with  water — may  occasionally  be  sub- 
stituted for  wine. 

Weak  infusions  of  tea  and  coffee  or  cocoa,  also 
made  without  sugar,  are  admissilile ;  these  may  be 
sweetened,  if  required,  with  minute  quantities  of 
saccharin  (not  more  than  1^  grain  of  tliis  substance 
should  be  taken  daily,  as  gastric  pains  and  disorders 
have  been  provoked  by  its  constant  use  in  larger  doses). 

As  to  wines,  it  is  desirable  to  notice  which  kinds 
(of  those  generally  permitted)  are  best  borne  by 
different  diabetics. 

All  saccharine  wines  (ports,  champagnes,  Sau- 
ternes,  etc.),  liqueurs,  and  beer  must  be  strictly 
avoided. 

To  resume  :  the  following  may  be  taken  as  the 
main  indications  to  be  satisfied  in  fixing  a  regime  for 
the  diabetic : — 

1.  Reduce  to  a  minimum  or  abolish  altogether  all 
sugar-foi-ming  foods,  i.e.  all  substances  containing 
starch  or  sugar. 

2.  Raise  to  the  physiological  maximum  all  flesh 
foods,  i.e.  give  as  much  animal  food — meat  of  all 
kinds — as  can  be  well  digested  and  assimilated. 

3.  Find  suitable  substances  to  replace  the  neces- 
sarily discarded  carbo-hydrates — and  these  are  to  be 
found  among.st  the  various  animal  and  vegetable  fats. 
Their  richness  in  carbon  renders  them  fitter  for  this 
purpose  than  albuminates. 

V  4.  Promote  muscular  activity  in  order  to  consume 

^        the  excess  of  sugar  in  the  blood. 

This  last  indication  must  be  applied  with  dis- 
crimination ;  and  it  must  be  remembered  that  in  the 
graver  forms  of  diabetes — the  thin  wasted  diabetics 
— much  muscular  exercise  is  ill  borne;  on  the  other 


Chap.  III.)   Alkaline  Waters  in  Diabetes.        387 

hand,  the  stout,  gouty,  glycosuric  patients  are  doubt- 
less benefited  by  exercise. 

I  have  already  alluded  to  the  value  of  alkaline 
waters  in  diabetes.  They  often  prove  of  so  much  use 
that  they  may  be  regarded  as  forming  a  fit  part  of 
the  diabetic  regime. 

Their  use  is  fi-equently  attended  by  a  diminution 
of  the  excessive  thirst,  a  disappearance  of  the  dis- 
tressing dryness  of  the  mouth,  by  a  less  frequent 
need  to  pass  water,  and  by  a  removal  of  cutaneous 
irritations  and  eruptions. 

The  mode  of  action  of  these  alkaline  waters  re- 
mains obscure  ;  but  their  good  effects  are  undoubted. 

It  is  scarcely  necessary  to  say  that  we  must  not 
expect  to  observe  these  good  results  of  the  use  of 
alkaline  waters  as  frequently  in  the  gi'aver  as  in  the 
slighter,  and  especially  in  the  gouty,  forms  of  diabetes. 

If  we  employ  the  stronger  alkaline  waters,  like 
those  of  Vichy  and  Vals,  we  may  direct  the  patient 
to  drink  from  3  oz.  to  6  oz.  half  an  hour  before  each 
meal ;  the  weaker  waters,  like  those  of  Neuenahr,  Ems, 
Apollinaris,  etc.,  may  be  taken  in  larger  quantity, 
and  may  be  used  to  mix  with  wine. 

In  diabetes,  as  in  nearly  every  form  of  disease 
which  we  are  called  upon  to  treat,  our  guiding  rule 
should  be  "discrimination/" 

We  must  adapt  our  regime  to  individual  cases, 
and  we  must  observe  carefully  whether  the  measures 
we  adopt  are  well  or  ill  tolerated  by  difierent  patients. 
"We  should,  therefore,  frequently  examine  our  patients' 
urine,  and  notice  what  influence  is  exercised  on  the 
amount  of  sugar  excreted  by  different  articles  of  food. 
We  should  also  weigh  our  patients  frequently  to 
ascertain  the  effect  of  the  dietary  adopted  on  the 
nutrition  of  the  body. 

If  we  follow  this  plan  we  shall  discover  that  some 
diabetics  may  be  permitted  a  much  more  liberal  and 
more  varied  dietary  than  others,  and  that  measures 
which  on  theoretical  grounds  might  appear  necessary, 
often  prove  practically  undesirable. 
z2 


388  Food  in  Disease,  [Pan  11. 

Von  Noorden,  in  his  already  quoted  work  on  Diabetes,* 
makes  some  very  judicious  ob?ervations,  from  the  above  point 
of  view,  on  the  diet  suitable  to  the  several  groups  of  diabetics, 
and  especially  as  to  the  extent  to  which  carbo-hydrates  may  be 
xdilised — the  object  to  be  kept  in  view  in  all  these  diet  schemes 
being  to  maintain  and,  if  possible,  increase  the  strength  of  the 
patient,  to  keep  stationary  or  even  increase  the  store  of  albumin  in 
the  body.  "  Any  diet,"  he  says,  "  which  is  not  adapted  to 
assure  the  maintenance  of  the  diabetic's  store  of  albumin  is,  in 
my  opinion,  unsuitable  for  long-continued  use;  it  may  be 
emploj'ed  temporarily,  but  as  a  permanent  thing  it  is  objec- 
tionable and  dangerous." 

He  points  out  that  "the  difficulty  of  affording  nourishment 
to  the  sufferer  from  diabetes  is  increased  in  inverse  proportion 
to  the  tolerance  of  cai"bo-hydrates.  While  in  the  case  of 
one  diabetic  we  are  able  to  give  such  an  amount  of  carbo- 
hydrates that,  although  a  small  proportion  is  lost  in  the  urine, 
the  large  remainder  suffices  to  cover  a  quantitatively  important 
part  of  the  daily  tissue  change,  in  another  no  advantage  worth 
mentioning  accrues  from  the  ingestion  of  carbo-hj'drates,  give 
them  in  what  quantities  we  will." 

But  we  are  not  compelled  to  banish  the  carbo-hydrates 
entirely  in  those  cases  in  which  a  certain  degi-ee  of  tolerance 
for  them  exists.  "  When,  for  example,  a  patient  excretes  no 
sugar  while  taking  .50  grammes  of  bread,  and  pei'haps  1 0  grammes 
of  sugar  while  taking  100  grammes  of  bread  daily,  wo  can  then 
permit  him,  with  a  good  conscience,  to  eat  from  50  to  100 
grammes  of  bread.  .  .  .  We  need  have  no  apprehension 
even  if  we  exceed  a  little  the  limits  of  tolerance  in  these  cases." 
He  further  very  wisely  remarks,  "  the  reduction  of  carbo- 
hydrates signifies  much  more  than  a  mere  game  of  hide-and- 
seek  with  the  gl}"cosui'ia.  Through  blind  indulgence  very 
material  injury  may  be  caused,  but  through  a  limitation  of  the 
ingestion  of  carbo-hydrates,  regulated  according  to  the  neces- 
sities of  the  individual  case,  a  very  positive  advantage  may 
be  gained."  But  he  further  adds,  "  for  every  really  grave  case 
of  diabetic  glj'cosuria  the  fat  and  flesh  diet,  to  the  exclusion  of 
carbo-hydrates,  is  to  be  regarded  as  the  ideal  regimen." 

It  is,  however,  important  also  to  bear  in  mind,  as  he 
observes,  that  individuals  who  have  been  for  a  certain  time — 
several  weeks,  for  instance— on  a  diet  containing  no  saccharine 
or  starchy  ingredients,  often  acquire  a  tolerance  of  carbo- 
hydrates, and  excrete  much  less  sugar  after  the  ingestion  of  a 
certain  quantity  of  amylaceous  food  than  they  did  before. 
"  The  sugar-consuming  function  of  the  body  is  spared  by  the 
temporary  withdrawal  of  carbo-hydrates,  and  is  thus  given  an 
opportunity  for  recovery  and  restoration  of  strength." 

Of  all  the  professed  substitutes  for  bread.  Von  Noorden 

•  "Twentieth  Century  Practice,"  vol.  ii.,  1895, 


Chap.  III.]    Von  NooRDEN:  Diet  FOR  Diabetics.  3559 

prefers  "Aleuronat"  bread,  because  with  a  comparatively  small 
proportion  of  carbo-hydrates  it  preserves  the  genuine  bread- 
taste,  and  many  diabetics  take  it  readily  for  months  at  a  time. 
His  observations  and  experience  as  to  the  value  of  alcohol  in 
diabetes  are  also  interesting.  It  is  very  useful,  he  thinks,  in 
carrying  out  the  "  fat  and  flesh  diet,"  as  it  facilitates  greatly 
the  ingestion  of  considei'able  quantities  of  fat  and  lessens  the 
risk  of  disgust  for  it  being  produced.  The  patient  should  take 
a  small  quantity  of  alcohol  with  or  after  fatty  food.  Cognac, 
whisky,  or  Kirsch,  or  good  Burgundy  may  be  taken — with  or 
without  soda-water. 

Alcohol  also  "  introduces  a  not  insignificant  amount  of  fuel 
into  the  body,"  and  it  saves  the  consumption  of  some  other 
non-nitrogenous  substance,  especially  fat. 

"Since  we  often  have  to  give  the  diabetic  very  large 
quantities  of  fat,  it  is  a  matter  of  great  importance  that  we 
perceive  in  alcohol  a  means  whereby  a  certain  reduction  in  the 
allowance  of  fat  can  be  effected."  But  we  must  not  use  it  in 
lar^^e  quantities  or  we  may  produce  its  poisonous  effect  on  the 
protoplasm  of  the  cells.  The  a^  or  ige  lim.it  to  the  daily  con- 
sumption of  alcohol  should  be  about  60  grammes  (2  ozs.),  or 
from  3  to  4  ozs.  of  brandy  or  whisky. 

It  is  especially  in  the  cases  in  which  a  long  indulgence  in 
alcohol  has  been  common  that  it  is  necessary  as  a  nervine  and 
cardiac  tonic.  In  the  aged  and  obese  with  arterio-sclerosis 
only  the  lightest  wines  should  be  used. 

In  order  to  apply  these  principles  to  the  practical  feeding 
of  diabetics,  he  finds  it  convenient  to  divide  them  into  the 
following  groups : — 

(1)  Cases  of  mild  glycosuria  in  elderly  persons. 

(2)  Alild  glycosuria  in  young  persons. 

(3)  Modemtely  severe  forms  of  glycosuria. 

(4)  Severe  forms  of  glycosuiia. 

(1)  This  fonn  of  glycosuria  is,  we  have  already  seen, 
benign.  The  amount  of  sugar  excreted  is  reduced  to  a  mere 
trace  by  a  considerable  abstraction  of  carbo-hydrates  from  the 
food.  It  is  better  in  these  cases  to  put  up  with  such  a  slight 
glycosuria  than  to  get  rid  of  it  by  a  rigid  exclusion  of  carbo- 
hydrates. Forbid  certain  articles  which  consist  entirely  or 
chiefly  of  carbo-hydiates — e.g.,  sugar,  pastry,  sweet  wines,  and 
dishes  made  with  flour,  rice  or  sugar.  Allow,  but  in  reduced 
amount,  beer  (I  to  2  glasses  daily),  or  a  little  light  wine.  The 
patient  may  be  allowed  also  to  eat  a  limited  amount  of  bread, 
potatoes,  and  other  vegetables  at  his  meals. 

In  the  obese  a  rapid  and  great  loss  of  weight  must  be 
guarded  against  by  an  increase  in  the  carbo-hydiates.  "  Dia- 
betics feel  better  and  are  better  protected  against  danger  when 
their  store  of  fat  is  above  that  desirable  for  the  healthy."     We 


39©  Food  in  Disease.  [Partii. 

should  urge  such  patients  to  the  free  use  of  butter  with  bread 
and  potatoes — to  eat  bacon  and  other  fat  meat  and  the  richer 
kinds  of  chee?e. 

(2)  This  form  in  young  persons  is  often  dependent  upon 
some  nervous  disturbance.  We  must  be  much  more  cautious 
about  allowing  carbo-hydrates  to  these  patients  than  to  the 
elderly,  because  there  is  much  more  danger  of  the  glyox)suria 
assuming  a  progressive  character.  "  In  view  of  the  varying 
intensity  of  the  glycosuria  in  young  persons,  it  is  advisable 
that  an  exact  determination  of  the  limits  of  tolerance,  accord- 
ing to  the  formula  already  given  (page  376),  should  be  made  at 
least  twice  a  year.''  It  is  undesirable  to  reduce  the  amount  of 
carbo-hydrates  in  the  diet  below  what  is  absolutely  necessary 
in  order  to  keep  the  glycosuria  in  check,  and  it  is  hurtful  to 
exceed  the  tolerance  to  any  appreciable  extent.  Milk  containing 
the  easily  decomposable  milk-sugar  he  commends  in  these  cases. 

"  The  best  means  of  determining  the  amount  of  carbo- 
hydrates that  can  be  allowed  is  by  the  addition  of  milk  to  the 
daily  bill  of  fare.  The  standard  diet  (page  376)  is  first  increased 
by  the  addition  of  one  litre  of  milk  a  day,  and  then  it  is  ascer- 
tained how  much  starch  (in  the  form  of  bread)  can  be  added  to 
the  food  without  giving  rise  to  glycosuria."  This  ought  to  be 
from  60  to  100  grammes.  The  carbo-hydrates  should  be 
restricted  to  bread  and  potatoes,  and  moderate  quantities  of 
fresh  vegetables  and  fresh  fruits,  but  the  bread  should  be 
limited  to  100  and  the  potatoes  to  150  grammes.  It  is  most 
important  with  this  class  of  patients,  whose  metabolic  changes 
are  much  more  active  than  in  the  elderly,  that  a  certain  fixed 
or  adequate  quantity  of  fatty  food  be  included  in  the  daily 
dietary.  The  drinking  of  2  pints  of  milk  daily,  one  in  the 
morning,  early,  the  other  in  the  evening,,  at  bed-time,  is  of 
great  value.  The  milk  should  be  sipped  slowly,  "at  least 
twenty  minutes  being  taken  in  its  consumption." 

The  daily  amount  of  fat  taken  should  vary  between  80  and 
100  grammes;  also  30  grammes  of  alcohol  in  some  form,  in 
order  to  economise  in  fat. 

The  following  represents  the  definite  quantity  of  fat-con- 
taining foods  which  must  absolutely  be  taken  in  the  twenty- 
four  hours : — 

Butter,  60  grammes  (with  bread,  bread  and  cheese,  and 

potatoes) . 
Olive  Oil,  10  grammes  (with  salad). 
Mich  Cheese,  30  gi-ammes. 
Eggs,  2. 
Milk,  1  litre. 
With  these  alcohol,  60  grammes  (in  some  dilute  form). 

The  patient  .to  consult  his  own  taste  with  the  rest  (nitrogenous 
part)  of  the  diet. 


Chap.  III.]    Von  Noorden:  Diet  for  Diabetics.  391 

Such  patients,  Von  Noorden  thinks,  often  do  well  at  a  milk 
cure  in  the  mountains,  where,  in  addition  to  the  other  suitable 
articles  of  diet,  3  litres  of  milk  may  be  taken  daily. 

(3)  The  moderately  severe  forms  comprise  those  cases  in 
which  the  excretion  of  sugar  is  arrested  or  reduced  to  small 
amounts  (10  to  20  grammes)  only  by  total  abstinence  from 
carbo-hydrates.  This  form  occurs  mostly  in  the  young  and 
middle-aged,  and  is  attended  by  emaciation  rather  than  obesity. 

Having  determined  the  limits  of  tolerance,  such  patients 
"  should  be  subjected  to  a  3-weeks'  course  of  complete  abstin- 
ence from  carbo-hydrates  at  least  twice  and  if  possible  three 
times  in  the  )'car,  while  in  the  intervals  a  certain  amount  of 
carbo-hydrates  may  be  allowed."  These  periods  can  be 
employed  to  determine  the  oscillations  of  tolerance. 

In  the  period  of  strict  abstinence  the  diet  of  such  a  patient 
must  be  made  as  varied  as  possible,  and  should  be  divided  into 
five  meals.  "The  dietetic  treatment  of  such  an  individual 
demands  the  sacrifice  of  time,  patience  and  thought." 

The  '^sample  hill  of  fare''''  suggested  for  this  period  will  be 
found,  with  others,  at  page  392  et  seqq. 

In  the  intervals,  the  tolerance  is  tested  directly  after  the 
"  strict  diet "  by  increasing  additions  of  bread,  and,  if  it  is 
found  to  be  raised,  more  carbo-hydrates  may  be  added,  and  a 
diet  similar  to  that  for  No.  2  group  established.  But  this  is 
rarely  practicable.  In  most  cases  4  ozs.  of  good  wheat  bread 
is  the  average  amount  permissible.  As  much  fat  as  possible 
must  be  introduced  into  the  diet,  in  one  way  or  another — 
butter,  cream,  bacon,  olive  oil,  yolks  of  egg,  marrow,  etc. — 
about  150  to  180  grammes  of  fat  daily.  He  should  take  also 
about  40  grammes  of  alcohol  per  diem  in  the  form  of  a  pint  of 
wine  and  one  glass  of  cognac  or  old  whisky. 

The  daily  consumption  of  fats  may  consist  of — 

Butter,  3  ozs. 

Olive  Oil,  1  to  2  tablespooufuls. 

Bacon,  20  grms. 

Five  medium-sized  hen's  eggs. 

These  fats  must  be  used  in  the  preparation  or  dressing  of 
other  foods,  and  as  much  ingenuity  as  possible  should  be 
applied  in  their  preparation. 

Tables  are  added  (I.,  II.,  III.,  and  IV.)  of  the  different 
foods  (I.)  allowable  unconditionally ;  (11.)  allowable  in  moderate 
quantity;  (III.)  conditionally  allowable;  and  (IV.)  especially 
valuable.  If  the  patient  is  content  to  take  "  Aleuronat "  bread, 
100  grammes  of  which  are  equivalent  to  50  grammes  of  ordinary 
bread,  he  is  then  allowed  2  pints  of  milk.  Von  Noorden  con- 
eiders  "  milk  cures  "  useful  in  some  of  these  cases.  All  the 
carbo-hydrates  may  be  given  in  the  form  of  milk — 3  litres  of 
milk  instead  of  150  grammes  of  bread.     These  are  "especially 


392  Food  in  Disease.  [Partii. 

lecomniendeci  in  gi-eatly- weakened  individuals  and  those  suffer- 
ing from  grave  complications.  They  should  not  be  continued 
in  general  longer  than  three  or  four  weeks  at  a  time,  Jind  are 
best  instituted  during  the  patient's  stay  in  the  country  or  in 
the  mountains."  These  cases  are  also  benefited  by  a  moderate 
Carlsbad  course. 

(4)  Severe  forms  of  glycosuria  are  those  in  which,  in  spite 
of  a  continued  diet  as  free  as  possible  from  carbo-liydrates, 
sugar  is  constantly  excreted  in  the  mine.  In  these  cases,  even 
although  the  carbo-hydrates  aggravate  the  diibetic  disturbance, 
Von  Noorden  maintains  they  "cannot  be  permanently  dispensed 
with.  They  are  always  to  be  regarded  as  incidental  articles  of 
diet,  or,  as  it  were,  luxuries,"  and  he  would  divide  the  refjime 
of  such  patients  into  (a)  &  period  of  strict  diet,  and  {b)  diet  in  the 
intervals. 

The  former  should  resemble  that  sketched  for  Group  3,  but 
it  must  be  much  stricter,  and  should  last  four  weeks  instead  of 
three,  and  take  place  almost  evei'y  quarter.  The  choice  should 
be  made  from  the  lists  of  "  nnconditionally  alloivahle  foods " 
(Table  I.)  and  "especiaUi/  valuable  foods"  (Table  IV,). 

(b)  III  the  intervals,  carbo-hydrates  in  restricted  quantities 
are  to  be  allowed.  "We  must,  despite  all  theoretical  opposi- 
tion, pennit  the  use  of  carbo-hydrates  to  almost  as  great  extent 
as  in  the  case  of  the  patients  in  the  preceding  categorj^,  who 
are  suffering  from  the  moderately-severe  forms  of  glycosuria." 
Of  the  "  uncondilioriallij  alio xable  foods''  he  may  take  any  he 
wishes,  and  always  in  large  amount ;  of  three  or  four  articles  of 
"foods  permissible  in  moderate  quantities'^  and  of  ^^conditionally 
allowable  foods"  he  should  take  amounts  equivalent  in  value  to 
from  80  to  120  grammes  of  white  bread. 

It  is  especially  necessary  in  these  cases  to  ensure  the  con- 
sumption of  an  adequate  quantity  of  fat,  "  for  fat  is  for  these 
patients  the  only  thing  upon  which  they  can  rely  to  maintain 
their  strength  and  prolong  their  lives."  Alcohol  they  also 
require  in  larger  amounts  than  the  milder  forms — as  much  as 
80  grammes  a  day — "  such  a  dose  being  justified  by  the  greater 
ingestion  of  fat,  the  tendency  to  heart  failure,  and  the  general 
nervous  exhaustion."  He  distributes  the  alcohol  about  the 
day  thus  : — A  pint  of  still  Jloselle  at  lunch,  a  pint  of  good  old 
Burgundy  at  dinner,  and  a  liqueur-glass  of  brandy  or  whisky 
three  or  four  times  a  day. 


Von  Noordek's  Sample  Bill  of  Fare 

for  modei-ately-severe  eases  during  the  periods  of  strict  abstinence 
from  carbo-hydrates. 

8  a.m. — (Ist  Breakfast.)    Mam,  100  grms. ;  a  cup  of  tea; 
a  glass  of  cognac. 


Chap.  III.]     FOJV  NOORDEN:  DiET  FOR  DlABETICS,    393 

10.30  a.m. — (2nd  Breakfast.)     2  eggs  fried  in  10  grms.  of 
butter. 

12.30  p.m. — (Luncheon.)  Cold  roast  meat,  \h^^^rxas,.\  mayon- 
nahe,  made  with  the  yolk  of  one  egg  and  one 
spoonful  of  qil ;  raiv  ciictimher,  with  5  grms.  of 
vinegar,  one  spoonful  of  oil,  salt  and  pepper ; 
Gorgonzol't  cheese,  15  grms.;  half-hottle  of 
Moselle;  a  cup  of  coffee  with  a  tablespoonful 
of  cream. 
5  p.m. — (Tea.)  A  cup  of  tea,  a  boiled  e^g,  and  a  glass 
of  cognac. 
7.30  p.m. — (Dinner.)  A  cup  of  hotiiUon,  with  15  grms.  of 
marrow  ;  boiled  salmon,  80  grms. ;  asparagus, 
i  to  5  lb.,  with  butter,  20  grms. ;  smoked  ox 
tougue,  30  gnns. ;  capon,  100  grms.;  salad,  with 
5  grins,  of  vinegar  and  a  spoonful  of  oil ;  half- 
botlle  of  Burgundy. 
10  p.m. — A  glass  of  cognac  with  seltzer-  water. 


Von  Noohden's  Diet  Tables. 
Table  I. —  Unconditionally  Allowable  Foods. 

Fresh  meat  and  fowl  (wild  or  domestic),  tongue,  heart,  brain, 
swectbre.ids,  kidneys,  marrow-bonos. 

Preserved  meats. — Dried  and  smoked,  or  salted. 

Fresh  fish,  cooked  without  any  farinaceous  sauce  or  addition 
of  any  kind,  and  eaten  with  butter  (plain  or 
melted). 

Preserved  fish . — Dried,  salted  or  smoked,  or  preserved  in  oil 
(sardines,  anchovies,  etc.).     Caviare,  cod-liver  oil. 

Shellfish. — Oysters,  mussels,  and  other  bivalves,  lobster, 
cray-fish,  crabs,  shrimps,  turtle. 

Meat  extracts  and  peptones. 

Eggs,  raw  or  cooked. 

Fats,  animal  and  vegetable. 

Fresh  vegetables. — Lettuce,  endive,  cress,  spinach,  cucumbers, 
onions,  leeks,  asparagus,  cauliflowers,  red  and  white 
cabbage,  son-el,  French  beans.  These  may  be  taken 
boiled  in  broth  and  dressed  with  butter,  lard,  or 
any  other  fat. 

Preserved  vegetables. — Pickles. 

Spices. — Salt,  pepper,  aiyenne,  curry,  cinnamon,  cloves,  nut- 
meg, mustard,  saffron,  anise-seed,  carraway-seed, 
parsley,  dill,  borage,  laurel,  capers,  olives,  garlic,  etc. 

Soups. — Clear  soups  and  broths,  with  or  without  eggs, 
marrow,  fresh  or  dried  vegetables  (Julienne),  clear 
turtle,  etc. 

Cheese,  especially  the  fatty  or  cream  cheeses. 


394  Food  in  Disease.  [Panii. 

Beverages. — Effervescing  natural  or  artificial  waters,  to  which 
may  be  added  lemon- juice,  saccharin,  glycerin,  and 
the  various  spirits— brandy,  rum,  etc. ;  light  Moselle 
or  Khine  wines,  claret,  or  Burgundy  ;  coffee,  black 
or  with  cream,  sweetened  with  saccharin ;  tea  in  the 
same  way,  or  with  rum. 


Table  II. — Articles  Permissible  in  Moderate  Quantities 

(containing  an  unimportant  amount  of  carbo-hydrates).     These 

dishes — if  two  to  four  are  selected  daily — offer  a  great  variety 

in  patients'  dietary. 

Calves'  liver,  giblets  (up  to  100  grms.),  liver  sausages,  meat 
sau-ages,  German  and  Frankfort  sausages,  sausage- 
meat  balls,  brawn.     60  to  100  grms. 

PsLte-de-foie-gras,  potted  beef,  ham,  tongue,  salmon,  lobster, 
anchovies.     \  to  1  tablespoonful. 

English  Sauces. — Worcester,  Harvey,  anchovy,  Indian  soy, 
etc.     1  tablespoonful. 

Cream. — 4  to  6  tablespoonfuls  a  day. 

Cocoa. — Prepared,  without  sugar.    25  grms. 

Cheese  of  all  kinds.     25  to  60  grms. 

Vegetables. — Salsify,    turnip-root,     celery,     turnip     greens, 
pumpkin.     2  tablespoonfuls. 
Green  peas,  beans,  carrots,  Brussels  sprouts.     1  table- 
spoonful. 
1^  artichoke,  1  truffle. 
Edible  mushrooms.     1  tablespoonful. 

Baw  ditto. — 8  radishes,  2.  sticks  of  celery,  2  medium-sized 
tomatoes. 

Nuts. — 2  walnuts,  6  hazel  nuts,  3  almonds,  a  thin  slice  of 
cocoanut,  8  Brazil  nuts. 

Fresh  Fruits. — 1  thin  slice  of  melon,  1  small  apple,  1  or  1^ 
peach,  1  spoonful  of  raspberries  or  strawberries, 
4  spoonfuls  of  currants,  6  greengages,  12  cherries, 
\  a  medium-sized  pear,  etc. 


Table  III. — Conditionally  Allowable  Foods. 

These  are  in  the  place  of  an  equivalent  quantity  of  bread, 
which  must  be  deducted  from  the  diet. 

The  quantities  ^50  grammes  of  white  bread. 

Milk,  1  litre  (or  IJ  litre  of  Russian  koumiss). 
Kephir,  1  to  1 J  litre  (prepared  without  sugar). 
Cream,  1  litre. 


Chap.  III.]    Fomr  Noorden's  Diet  Tables.  395 

Rye    bread,     Graham    bread,     or    pumpernickel,     60     to 

65  grms. 
Aleuronat  bread  (Ebstein's  formula),  100  grms. 
Zweibach  (made  without  sugar),  and  other  cakes,  35  grms. 
Cocoa  and  chocolate,  30  to  40  grms. 
Chestnuts  (unshelled),  60  grms. 
Cane  sugar,  35  grms. ;  fruit  or  milk  sugar,  40  grms. 
Sweet  compotes,  35  grms. 
Fruit  jam,  50  grms. 
Money,  40  grms. 
Flour. — "Wheat,   rye,   barley,   oat,   40   grms. ;    bean,   pea, 

lentil,  45  grms. 
£iee,  and  other  starch  preparations — macaroni,  oatmeal — 

35  grms. 
Lentils,  peas,  beans  (weighed  dry),  50  grms. 
Green  peas,  100  grms. 

Potatoes,  new,  180  grms. ;  winter,  140  grms. 
Apples,    pears,    plums,    apricots,    cherries,    grapes,    etc., 

120  grms. 
Strawberries,  raspberries,  mulbeiTies,  currants,  bLickbomes, 

etc.,  200  grms. 
Peaches,  3. 

Raisins  or  dried  dates,  40  grms. 
Figs,  50  grms. 
Bananas,  3. 

Walnuts,  hazel  nuts,  almonds,  or  Brazil  nuts,  a  b:indfal. 
Beer,  §  litre. 
Sweet  wine,  ^  litre. 


Table  FV. — Especially  Valuable  Foods 

on  account  of  their  richness  in  albumen  and  fat. 

100  grammes  of  each. 

Oil  (vegetable). 

Putter. 

Bacon  and  ham. 

Devonshire  and  other  cream. 

Cream,  Cheddar,  Brie,  and  other  cheeses. 

German  sausage  (Cervelat  wurst). 

Fat  pork,  beef,  mutton,  goosei 

Smoked  ox  tongue. 

Yolk  of  egg. 

Eels. 

Smoked  mackerel. 

Caviare. 

Fat  sidmon,  fiesh  or  smoked. 


396 


Food  in  Disease. 


[Part  11. 


DIABETIC     DIETARIES. 


Sanctioned : 


1.— Paty'b.* 


Butcher's  meat  of  all  kinds, 
except  liver. 

Ham,  bacon,  and  other  pre- 
served meats. 

Poultry  and  game. 

Fish  of  all  kinds,  fresh  and 
cured,  including  the  Crus- 
tacea. 

Animal  soups,  beef- tea,  and 
broth  (not  thickened). 

Eggs,  cheese,  cream  cheese, 
cream,  butter. 

Almond,  bran,  or  gluten  substi- 
tutes for  ordinary  bread. 

Greens,  spinach. 

Tumip-tops,  watercress. 

Mushroom,  mustard-and-cress. 

Cucumber,  lettuce,  endive. 

Radishes,  celery. 

And  the  following  only  in  mode- 
rate quantity,  after  boiling  in 
much  water : 

Turnips,  French  beans. 

Brussels  sprouts,  cabbage. 

Cauliflower,  broccoli,  sea-kale. 

Asparagus,  vegetable-marrow. 

Pickles,  olives,  vinegar,  oil. 

Jelly,  flavoured,  but  not  sweet- 
Savoury  jelly. .  [ened. 

Blanc-man  ge.made  with  cream 
and  not  milk. 

Custard,  made  without  sugar. 

Nuts  of  all  kinds,  except 
chestnuts. 


Forbidden  : 
Sugar  in  any  form. 
Wheaten  bread  and  ordinary 

biscuits  of  all  kinds. 
Rice,  arrowroot. 
Sago,  tapioca. 
Macaroni,  vermicelli. 
Potatoes,  carrots. 
Parsnips. 
Beet-root. 
Peas. 

Spanish  onions. 
Pastry    and  puddings    of  all 

kinds. 
Fruits  of  all  kinds,  frosh  and 

preserved. 


Tea,  coffee,  cocoa  from  nibs. 

Dry  sherry,  claret,  hock. 

Dry  Sauterne,  Chablis,  Bur- 
gundy. 

Brandy  and  spirits,  un- 
sweetened. 

Soda-water. 

Burton  bitter  ale  in  moderate 
quantity. 


Beverages. 


Milk,  except  sparingly. 
Sweet  ales,  mild  and  old  por- 
ter and  stout,  cider. 
AU  sweet  and  spai-kling  wines. 
Port  wine,  unless  sparingly. 
Liqueurs. 


'Food  and  Dietetics."    2nd  edition,  1876. 


Chap.  III.]' 


Diabetic  Dietaries. 


397 


2. — Seeoen's.* 


Sanctioned  : 


In  any  qnantity  : 
Flesh  of  all  kinds  :  preseryed 

(smoked)  meats,  ham. 
Tongue,  bacon. 
Fish  of  all  kinds. 
Oysters  and  shell-fish. 
Crabs,  lobsters. 
Animal  jellies. 
Aspic. 
Eggs,  caviare,  cream,  butter, 

cheese. 
Spinach,  cooked  salads,  endive. 
Cucumber,  green  asparagus. 
Watercress,  sorrel. 
Artichokes,  mushrooms. 
Nuts. 

In  small  quantity ; 

Cauliflower,  caiTots. 

Turnip,  white  cabbage. 

Green  beans. 

Beiries,  such  as  strawberries, 
raspberries,  currants;  also 
oranges  and  almonds. 


Forbidden . 


Farinaceous  foods  of  all  kinds. 

(^Bread  only  in  very  small  quan' 
tity  according  to  the  discretion 
of  the  physician.) 

Sugar. 

Potatoes,  rice,  tapioca. 

Arrowroot,  sago,  groats. 

Peas,  beans. 

Sweet  fruits,  as  grapes,  cher- 
ries, peaches,apricots,plums, 
and  all  kinds  of  dried 
fruits. 


Beverages. 


In  any  quantity  : 

Water,  soda-water. 

Tea,  coffee. 

Bordeaux  and  Rhine  and  Mo- 
selle wines. 

Austrian  and  Hungarian  table 
wines. 

In  short,  all  wines  that  are 
not  sweet,  and  that  contain 
only  a  moderate  amount  of 
alcohol. 

In  very  small  quantities  : 
Milk,  unsweetened. 
Almond  emulsion. 
Brandy,  bitter  beer. 
Lemonade,  unsweetened. 


Champagne  and  sweet  wines 
and  beers,  must,  fruit 
wines  and  fruit  juices  and 
syrups. 

Sweet  lemonade. 

Liqueurs. 

Ice  and  sorbets. 

Cocoa  and  chocolate. 


•  "  Der  Diabetis  Mellitus."    Berlm,  1876. 


398 


Food  in  Disease. 


[Part  U. 


3. — Sia  William  Roberts's. 


Sanctioned , 

Butcher's  meat. 
Poultry  and  game. 
Fish. 
Cheese. 


Butter,  fat,  and  oil. 
Broths,    soups,     and    jellies, 
made  without  meal  or  sugar. 
Cabbage,  endive,  spinach. 
Broccoli,  Brussels  sprouts. 
Lettuce,  spring  onions. 
Watercress,mu8tard-and-cre88 
Celery. 

Substitutes  for  bread : 
Bran-cake,  gluten  bread  (and 

meal),  almond  meal,  rusks 

and  biscuits. 
"  Ton-ified  "  or  charred  bread. 


Forbidden  : 

All  saccharine  and  farinaceous 

foods. 
Bread,  potatoes. 
Rice,   tapioca,    sago,    arrow- 

root,  macaroni,  etc. 
Turnips,     carrots,     parsnips, 

beans  and  peas. 
Liver  (contains  much  sugar- 
forming    substances),    and 
therefore 

Oysters  (  containing 
Cockles  I  enormous 
Mussels  (      livers. 

The  "pudding"  of  crabs  and 
lobsters. 

All  stveet  fruits,  as  apples, 
pears,  plums,  gooseberries, 
currants,grape8,oranges,etc. 


Beverages. 


Dry  sherry,  claret,  bitter  ale. 

Brandy  and  whisky  (in  small 
quantities). 

Tea,  coffee  (no  sugar),  choco- 
late (made  with  gluten 
meal),  soda-water,  bi-tar- 
trate  of  potash  water. 


Port  and  all  sweet  wines. 
Sweet  ales  and  porter. 
Rum  and  sweetened  gin. 


4. — Germain  See's.* 

L — All  kinds  of  animal  flesh,  boiled  or  roasted. 

Ham,  bacon. 

All  kinds  of  fish,  Crustacea,  oysters. 

Eggs,  cheese  (well-kept). 
2. — Fats  of  all  kinds,  butter,  lard,  and  sauces  without  flour. 
3. — Permits  5  oz.  of  bread  or  potatoes  daily. 
4. — Also  roots  and  green  vegetables. 
6.— Sacchaiin,  to  replace  sugar. 
6. — Forbids  milk  as  a  general  rule. 
7. — Considers  the  best  beverages  to  be  wines  that  are  not  sweet, 

and  tea  and  coffee,  without  sugar. 
8. — Recommends  Vichy  water  before  meals,  especially  in  gouty 
cases. 

♦  "Dn  R^me  Alimentaire."    Paris,  1887. 


Cnap.  III.]  Diabetic  Dietaries.  399 

6. — Dujardin-Beaumetz's. 

He  adopts  with  little  modification  the  dietary  of  Bonchardat. 
„  strongly  recommends  the  substitution  of  potatoes  cooked  in 

tbe  oven  for  bread,  even  gluten  bread ;  also  the  use  of  soya 

bread. 
„  prescribes  soupi  made   with  fatty  substances,   and    with 

poached  eirgs ;  also  vegetable  soups  made  with  cabbage, 

onion,  Julienne  soup,  but  without  turnips  and  carrots ; 

and  soups  made  with  potato  and  leek. 
„  allows  all  kinds  of  animal  food,  fish,  molluscs,  and  Crus- 
tacea, and  cautions  against  the  use  of  sauces  containing 

flour. 
,,  recommends  all  kinds  of  fats. 
,,  allows  such  vegetables  as  spinach,  sorrel,   French  beans, 

lettuce,  cabbage,  asparagus,  celery,  artichoke,  dandelion, 

and  all  salads. 
„  forbids  beet-root,  carrots,  turnips,  and  allows  only  small 

quantities  of  onions  and  leeks. 
„  rejects  all  fruits  but  gooseberries  ! 
„  advises  for  beverages,  wine  mixed  with  a  natural  alkaline 

water;    light  infusions  of  tea  and   coffee,   if  required, 

sweetened  with  glycerin,  but  without  sugar  and  milk. 
Also  to  relieve  the  thirst,  bitter  infusions,  as  of  quassia  and 

cinchona. 
Milk  he  forbids  entirely. 
jii  specialities  he  recommends  sardines  in  oil,  thon  in  oil,  foif- 

gras,  caviare,  and  Filets  d^harenp  saure  a  la  Norvegienne. 

6. — Bouchardat's. 
Sanctioned  :  Forbidden  : 

All  kinds  of  meat  (150  to  200      All  substances  rich  in  carbo- 
grammes     of     fat     daily),  hydrates, 

cooked  in    any    way,   but      Milk, 
without  meal  or  sugar. 

All  kinds  of  fish. 

Lobsters,  crabs,  oysters. 

Snails. 

Eggs. 

Cream. 

Cabbftge,  lettuce,  spinach,  ar- 
tichokes, asparagus,  green 
beans,  etc. 

Peaches  and  strawberries. 

Substitute  for  bread :  gluten 
bread. 

Beverages. 
Claret  or  (  For  men  1  pint  to 

Burgundy  \      1^  pint  daily. 


400  Food  in  Disease  (Part  ii. 

7. — Cantani'b. 

{This  is  a  very  exclusive  diet.) 

Sanctioned :  Forbidden  : 

Meat  and  animal  fats  of  all  Ziver. 

kinds  (at  all  meals).  Butter,  as  it  contains  traces  of 

Fish  of  all  kinds.  lactose. 

Lobsters.  Cheese. 

Olive  oil  (instead  of  butter).  Milk. 

Eggs  (in  milder  cases).  All  farinaceous  and  saccharine 

Substitute  for   bread :   Tavy's  foods  absolutely. 

almond  cakes  (only  for  con-  All  fruits, 

valescents  who  cannot  en-  All  gieen  vegetable  and  roots, 
tirely  dispense  with  bread). 

Beverages. 

Pure  water.  Lemonade. 

Soda-water.  Chocolate. 

Persons  habituated  to  the  use       Vinegar, 
of  strong  wines  and  spirits       Rum,  cognac, 
may  add  to  the  water  10  to       Tea     and     coffee    (in    severe 
30  grammes  of  pure  alcohol  cases), 

daily. 

Red  wine. 

Tea  and  coffee  in  small  quan- 
tity in  milder  cases. 

Cantani  considers  much  salt  injurious,  as  well  as 
much  pickled  pork  or  salt  fish. 

He  requires  the  adoption  of  this  absolute  meat 
and  fat  diet  for  three  months — in  very  mild  cases  for 
two  months,  in  very  severe  cases  for  six  or  nine 
months.  If  after  two  months  the  urine  contains  no 
sugar,  he  allows  green  vegetables ;  after  another 
month,  cheese  and  old  red  wine ;  and  after  another 
fortnight,  almonds  and  nuts.  A  month  or  so  after 
this  he  permits  juicy  fruits,  not  too  sweet,  as  straw- 
berries, raspberries,  peaches,  apples,  and  sour  oranges ; 
still  later,  plums,  gooseberries,  green  beans  and  peas, 
tomatoes,  melons,  cucumbers,  and  gourds.  After 
another  fortnight,  milk  and  fresh  milk  foods  may 
be  used. 

Finally,  if  after  repeated  examination  no  sugar  be 
found  in  the  urine,  small  quantities  of  farinaceous 


Chap.  111,1  Diabetic  Dietaries.  401 

food  may  be  cautiously  permitted,  but  their  use  must 
be  restricted  for  life.  It  is  best  to  avoid  altogether 
cane-sugar  and  sweets  of  all  kinds. 

Cantani  urges  the  consumption  of  as  much  fat  as 
possible,  and  especially  of  "  pancreatic  fat,"  as  easy  of 
digestion.  It  is  prepared  of  pancreas,  cut  up  into 
small  pieces,  well  mixed  with  a  certain  quantity  of 
melted  bacon  fat  or  lard,  left  to  undergo  an  artificial 
digestion  for  about  three  hours,  and  finally  lightly 
roasted  before  the  fire.  In  mild  cases  he  prescribes 
pure  sugar-free  cod-liver  oil,  in  20-  to  100-gramme 
doses. 

8. — Ebstein's. 

Ebstein  maintains  that  every  case  should  be  indivi- 
dualised. The  food  he  prescribes  depends  on  the  age 
and  individuality  of  the  patient.  For  thin  persons 
he  prescribes  more  fat  than  for  corpulent  ones. 

Eakly   Bueakpast. 

One  cup  of  coffee  or  tea  (black),  without  milk  and  sugar. 
White  broad  toasted,  30  to  50  grammes ;  or  brown  bread, 

well  buttered — butter,  20  to  30  grammes. 
The   yolk  of  an  egg,  a  little  fat  ham,  or  some  German 

sausage  (if  required). 
If  any  food  he  needed  between  this  meal  and  dinner,  let  it  be  a 

cup  of  broth,  with  the  yolk  of  an  egg. 

DiNNEK. 

Broth,  with  yolk  of  egg  or  marrow  (the  marrow-bone  is 

boiled  for  half  an  hour,  to  solidify  the  marrow).    Some 

peptone  may  be  added  to  the  broth. 
Meat  (180  grammes,  free  from  bone),  roasted,  boiled,  or 

stewed — beef,  mutton,  pork,  veal,  fowl,  or  venison  (fat 

meat  preferred). 
Gravies,  with  cream  or  yolk  of  egg,  not  flour. 
Ovfish,  with  melted  butter. 
Vegetables,  prepared  with  much  fat ;  purees  of  leguminous 

plants.     ISalads,  dressed  with  vinegar  and  oil,  and  some 

creaTn. 
The  food  should  be  well  salted  and  spiced. 
After  dinnei;  a  cup  of  coffee  or  tea. 

A  A 


402  Food  in  D/6£ASE.  [PartlL 

Supper. 

••One  cup  of  tea  or  broth. 

Meat  roasted,  ham  or  cheese,  or  an  egg,  or  fish,  caviare. 
Bread  30  to  50  grammes,  with  butter,  20  to  30  grammes. 
Apples,  pears,  and  stone  fruit  are  allowed  in  small  quantities. 

Beverages. 

He  forbids  absolutely  the  use  of  beer,  limits  the  use  of 
spirits,  and  allows  about  half  a  bottle  of  wine  daily. 

If  the  patient  digests  mi/k  well,  he  allows  it  in  moderate 
doses,  and  cream  especially. 

9. — DiJRING's. 

This  dietary  differs  from  most  others,  and  is 
founded  on  the  theory  that  the  most  important  factor 
in  the  causation  of  diabetes  is  a  faulty  diet  and 
disturbed  digestion.  During  therefore  insists  only  on 
a  I'estricted  diet  and  the  selection  of  the  most 
digestible  foods. 

For  Eably  Breakfast. 

Milk,  with  a  little  coffee,  but  no  sugar  (some  lime-water  to 
prevent  milk  from  becoming  sour  in  stomach). 

Stale  white  bread,  ad  libitum. 

Or  oatmeal,  barley,  or  rice-gruel,  made  with  water,  a  little 
salt,  but  no  butter  (if  bread  cannot  be  borne). 

For  2nd  Breakfast. 

"White  bread,  stale  and  well-baked. 

An  egg  lightly  boiled. 

Rice  or  oatmeal  gruel,  with  or  without  milk,  a  breakfast- 
cupful. 

Or  half  a  glass  of  good  red  wine  (with  water  in  certain 
cases). 

For  Dinner  (taken  between  2  and  3  o'clock). 

Soup,  with  rice,  barley,  or  oatmeaL 

Meat,  roast,  250  gi-ammes  (game,  ham,  and  smoked  meats  as 

free  from  fat  as  possible,  are  permissible),  no  condi- 

ments,  no  fatty  sauces. 
Compdte  of  dried  apples,  plums,  cherries. 
Dried  peas  or  white  beans,  in  some  cases. 


Chap.  III.]  Diabetic  Dietaries.  403 

Oreen  vegetables,  asparagus,  French  beaus,  carrots,  cauli- 
flowers, cabbages  (boiled  in  water  with  salt,  not  with 
fat  or  stock). 

Dessert  of  a  little  raw  fruit,  apples,  cherries,  and  one  small 
glass  of  red  wine,  diluted  with  water. 

For  Supper  (about  7  p.m.). 

Gruel  of  barlej-,  oatmeal,  or  rice,  with  salt  (but  no  butter), 

and  strained.     In  some  cases  may  be  made  with  milk. 
Ice  or  iced  water,  to  relieve  thirst  between  meals. 

He  lays  great  stress  on  the  mode  in  which  these 
vegetable  foods  are  prepared ;  especially  the  cereals 
used  for  making  gruel  and  the  legumes  are,  before 
being  cooked,  to  be  steeped  for  some  time,  and  boiled 
long  enough  to  make  them  more  easily  digested. 

The  following  list  of  dishes  which  the  diabetic 
patient  may  eat,  even  when  on  a  strict  regime,  will 
show  that  he  has  still  a  considerable  variety  of  foods 
accessible  to  him ;  we  divide  them  into  those  for 
breakfast,  dinner  (early),  and  supper  : — 

Breakfast. 

Eggs,  boiled,  buttered,  poached  and  served  on  puree  of  green 

vegetable  (spinach,  lettuce,  Brussels  sprouts,  etc.). 
Curried  eggs. 
Omelette  de  jambon. 

„         savoury. 
Ham  or  bacon,  cold  (boiled)  or  grilled. 
Chicken  or  game,  cold  or  grilled. 
Brawn. 
Spiced  beef. 

Kidneys,  grilled  with  puree  of  green  vegetable. 
.   Grilled  bones. 
Finnan  haddock,  grilled  and  eaten  with  fresh  butter. 
Soles,  fried  in  butter,  or  grilled  and  ditto. 
Herrings,  fresh,  fried  or  grilled,  and  with  butter,  or  with 

mustard  sauce. 
,,  kippered. 

Salmon,  smoked. 

Cod's  roe  smoked  and  grilled,  eaten  with  fresh  butter. 
Mushrooms,  stewed. 
Beverages. — Tea,   coffee,  cocoa,  with  or  without  saccharin 

and  cream,  or  cream  and  ApoUinaiis  water,  or  hock  or 

claret  and  seltzer-water. 

A  A  2 


404  Food  in  Disease.  [Panii 

Dinner. 
{Better  if  taken  early.) 

Soups. — Purees  of  gi-een  vegetables  (as  spinach,  sorrei, 
lettuce),  celery,  Julienne,  tomato,  game  soup,  hare 
soup,  bisque  soup,  clear  turtle,  clear  soups  with  savoury 
herbs,  or  with  grated  Parmesan  cheese,  or  with 
poached  eggs,  creme  de  Voluillo. 

(Care  must  be  taken  not  to  use  any  thickening  of  starch,  or 
any  sugar  or  sweet  wine.) 

Fish. — Oysters  (variously  cooked  or  raw) ;  soles,  boiled, 
grilled,  fried,  or  cold  fillets  with  aspic  jelly;  salmon, 
grilled  in  slices  with  boiled  cucumber  and  savoury 
sauce,  or  boiled  or  water-douched ;  turbot,  cod,  mullet, 
etc.  etc.  etc. 

Crab  and  lobster,  with  green  salad. 

(Green  salads  with  cream  and  oil  dressing  may  be  server 
with  any  of  these.) 

Beef,  mutton,  pork,  veal,  goose,  turkey,  chicken,  ducks, 
game,  wild-fowl,  hare,  rabbit,  sweetbreads. 

These  may  be  cooked  in  a  variety  of  ways — e.ff.,  mutton 
cutlets  or  pork  chops  with  puree  of  tojnatoes,  spinach, 
or  lettuce  ;  pheasant  boiled  with  celery  sauce  ;  chicken, 
game,  and  other  meats  may  be  served  cold  with  aspic 
jolly  and  pickles  or  cucumber,  or  made  into  rissoles 
with  pai-slej'  and  other  savoury  herbs. 

Vegetables,  green,  in  purees  with  meat-gravy  or  cream  : 

Lettuce,  spinach,  sorrel,  sprouts,  turnip  gi-eens,  Scotch 
kale;  asparagus,  green,  with  plain  melted  butter,  and 
tarragon  flavouring ;  French  beans,  tomatoes,  stewed 
celery,  vegetable-marrow,  cucumber,  boiled  and  served 
with  meat-gravy  ;  and  mushrooms,  grilled. 

GoosebeiTy  or  green-currant  fool,  custaid  pudding,  almond 
pudding,  junket. 

Supper. 

Any  of  the  meats  or  fish,  cold  or  grilled,  already  mentioned, 
with  salad,  cream  or  other  rich  cheese ;  lobster  mayon- 
naise; omelettes,  savoury,  au  jambon  ;  cauliflower  au 
gratin ;  foie-gras,  chicken,  devilled  ham,  turkey  and 
French  beans  ;  custard  puddini;- ;  sardines,  caviare,  or 
Finnan  haddock  on  gluten-bread  toast. 

Much  ingenuity  may  be  usefully  applied  to  vai-ying  the 
mode  of  cooking  and  serving  these  various  articles  of 
food.  The  several  diabetic  substitutes  for  bread  may 
be  utilised  in  their  preparation. 


405 


CHAPTER   IV. 

DIET    IN    ALBUMINURIA. 

The  presence  of  albumen  in  the  urine  occurs  under  a 
variety  of  circumstances  differing  greatly  in  their 
significance  and  seriousness.  Some  of  the  abnormal 
conditions  which  give  rise  to  the  pi-esence  of  albumen 
in  the  urine  are  temjjorary  and  comparatively  unim- 
portant ;  others  are  more  or  less  permanent  and  of 
extreme  seriousness. 

It  is  to  the  latter  that  the  term  "chronic  Briglit's 
disease  "  is  usually  applied,  and  the  morbid  condition 
then  associated  with  the  albuminuria  is  the  existence 
of  organic  structural  changes  in  the  kidneys  them- 
selves.    These  are  cases  of  "chronic  renal  "  disease. 

The  presence  of  albumen  in  the  urine  occurs  also 
temporarily  in  the  course  of  many  acute  febrile  dis- 
orders, a.s,  for  instance,  in  the  exanthemata,  especially 
in  scarlet  fever,  in  diphtlieria,  and  indeed  in  nearly 
all  severe  forms  of  acute  febrile  diseases  in  some  part 
of  their  course. 

Some  of  the  instances  of  chronic  Bright's  disease 
no  doubt  originate  in  acute  inflammatory  affections  of 
the  renal  organs,  "acute  Bright's  disease,"  and  these 
may  occur  without  the  coexistence  of  any  other  febrile 
malady. 

Albumen  may  occasionally  and  temporarily  be 
present  in  the  urine  in  connection  with  dy.spepsia, 
and  from  improper  feeding,  or  from  over-exertion,  too 
rapid  growth,  and  other  debilitating  influences. 

Albuminuria  from  passive  hyperoemia  of  the  renal 
vessels,  as  a  part  of  that  general  venous  obstruction 
dependent  on  chronic  heart  and  lung  disease,  forms  a 
part  of  the  clinical  history  of  those  affections,  the 
dietetic  management  of  wiiich  will  be  sul>sequently 
considered. 


4o6  Food  in  Disease.  [Part  ii. 

We  are  now  chiefly  concerned  with  those  instances 
of  albuminuria  in  which  appropriate  dietetic  treatment 
is  called  for,  and  of  these  the  cases  of  so-called  chronic 
Bright's  disease  are  by  far  the  most  important. 

The  question  whether  a  diet  rich  in  albumen,  or 
an  excess  of  albuminous  ingesta,  can  give  rise  to 
albuminuria  has  been  investigated  experimentally  by 
many  observers  with  somewhat  conflicting  results. 

It  is  generally  admitted  that  when  albuminuria 
exists  certain  kinds  of  food  will  often  cause  a  great 
increase  in  the  quantity  of  albumen  excreted  in  the 
urine;  but  it  is  by  no  means  so  generally  allowed 
that  a  temporary  albuminuria  can  be  produced  by 
excess  of  certain  kinds  of  food  in  the  same  way  as 
temporary  glycosuria  can  be  brought  about. 

Certain  instances  have  undoubtedly  been  observed 
of  persons  who,  when  apparently  in  good  health,  pass 
albuminous  urine  after  a  large  meal,  or  after  prolonged 
muscular  eflToi-t,  but  who  do  not  do  so  when  fasting  or 
after  repose. 

It  is,  however,  doubtful  if  it  is  strictly  correct  to 
call  this  "  physiological  albuminuria,"  and  the  ex- 
planation put  forward  by  Leube  of  this  circumstance 
is  probably  the  true  one — viz.  that  it  only  occurs  in 
persons  who  inherit,  or  are  born  with,  an  abnormality 
of  the  renal  structure  in  the  form  of  a  diminished 
resistance  in  the  renal  filter  to  the  passage  of 
albumen. 

Prof.  Sir  T.  Grainger  Stewart  has  instanced 
"  cheese,  pastry,  and  eggs,"  as  forms  of  food  which  he 
has  observed  to  be  capable  of  inducing  albuminuria 
in  certain  persons,*  and  he  mentions  the  case  of  a 
medical  colleague  who  whenever  he  indulged  in  pastry 
or  cheese  was  pretty  sure  to  suflfer  from  albuminuria, 
with  puffiness  of  the  eyelids. 

It  has  also  been  shown  by  several  observers  that 

egg-albumen    injected    into    the    veins    of    animals 

(Stockvis),  or  under  the  skin  (Semmola),  or  into  the 

rectum,  is  followed  by  albuminuria.     There  is  nothing 

•  "Lectures  on  Important  Sjnnptoms  :  Albuminuria,"  p.  145. 


Chnp.  IV.]        Albuminuria  from  Food.  .407 

to  be  wondered  at  in  this,  seeing  that  the  albumwi 
injected  in  these  experiments  has  not  undergone 
any  digestive  changes,  has  not  been  peptonised, 
is,  therefore,  in  an  unassimilable  condition,  and  is 
consequently  excreted  from  the  blood  by  the  kidneys; 
whereas  when  serum-albumen — i.e.  albumen  which  has 
undergone  the  digestive  process  and  become  assimilable 
— is  similarly  injected  no  albumen  appears  in  the  urine. 

But  it  has  been  also  asserted  that  egg-albumen 
taken  into  the  stomach  in  large  quantity  will  cause 
albuminuria. 

Setting  aside  individual  peculiarities  (a  few  indi- 
viduals can  never  take  eggs  in  any  form  without  suf- 
fering disturbances  of  health),  great  discrepancies 
occur  in  the  observations  made  as  to  this  point  by 
different  experimenters. 

Stockvis  and  some  others  have  stated  that  in 
animals  and  in  themselves  they  have  found  that 
when  egg-albumen  (uncooked)  was  taken  into  the 
stomach  in  large  quantity  a  portion  of  it  was  excreted 
in  the  urine.  Stockvis  suggested  as  an  explanation 
of  this  fact  that  a  portion  of  the  uncoagulated 
albumen  entered  the  blood  unaltered,  and  was, 
therefore,  eliminated  as  unassimilable.  Nussbaum, 
Coats,  and  D'Arcy  Power  claim  to  have  Been  albu- 
minuria produced  in  the  same  way.  Lauder  Brunton, 
however,  failed  to  pi'oduce  albuminuria  by  swallowing 
six  raw  eggs  in  succession ;  and  Dr.  Maguire  swal- 
lowed the  whites  of  twelve  raw  eggs  without  pro- 
ducing albuminuria. 

Another  observer*  ate  nineteen  raw  eggs  in 
thirty-six  hours  without  producing  albuminuria. 

The  probable  explanation  of  these  discrepancies 
in  the  results  which  have  been  obtained  from  eating 
raw  eggs  is  simple  enough.  We  are  familiar  with  the 
great  variation  in  the  rapidity  of  digestion  and  the 
capacity  of  digesting  different  articles  of  food  in 
different  individuals.  In  those  in  whom  the  digestion 
of  albuminous  food  is  slow  and  limited,  if  fed  on  raw 
*  Dr.  Dobradin,  quoted  by  Sir  T.  Grainger  Stewart. 


4o8  Food  in  Disease.  [Panii. 

eggs,  some  of  the  egg-albumen  escapes  digestion,  and 
passes  into  the  blood  unaltered,  just  as  it  might  do  if 
injected  into  tlie  rectum ;  while  in  others,  whose 
capacity  for  the  rapid  digestion  of  albumen  is  great, 
a  far  greater  amount  of  egg-albumen  can  be  digested 
and  assimilated  in  a  short  time. 

It  has  also  been  stated  that  albuminuria  can  like- 
wise be  produced  by  eating  an  excessive  quantity  of 
cooked  eggs,  and  the  authority  of  Claude  Bernard  is 
quoted  in  support  of  this  statement. 

The  results  of  some  experiments  instituted  by 
Prof.  Sir  T.  Grainger  Stewart*  led  him  to  the  con- 
clusion "  that  the  introduction  of  raw  egg-albumen 
into  the  stomach  induces  albuminuria ;  that  the 
albumen  is  always  in  small  quantity  ;  that  it  dis- 
appears when  ordinary  diet  is  resumed  ;  and  that  it 
is  not  egg-albumen  but  serum-albiimen  which  is  dis- 
charged." 

If  we  examine  Prof.  Sir  T.  Grainger  Stewart's 
cases,  we  find  one,  a  case  of  "  locomotor  ataxia," 
took  ten  raw  eggs  daily,  in  addition  to  his  ordinary 
diet,  for  a  period  of  nine  days.  Albumen  appeare<l 
in  the  uiine  after  two  days. 

One,  a  case  of  "  mitral  incompetence,"  took  nine 
eggs  daily  for  seven  days.  Albumen  appeared  in  the 
urine  on  the  first  day. 

One,  a  case  "free  from  organic  lesion,"  took  ten 
eggs  daily  for  three  days,  in  addition  to  the  ordinary 
diet,  and  albumen  appeared  in  the  urine  from  the 
first  day. 

And  in  the  fourth,  a  case  of  chorea,  "  the  eggs 
were  not  well  borne  by  the  stomach,"  and  the  albu- 
men in  the  urine  may,  therefore,  have  been  the  result 
of  dyspepsia. 

We  should  be  disposed  to  take  exception  to  all 
but  one  of  these  cases. 

The  well-known  digestive  abnormalities  of  the 
ataxic  should  have  rendered  such  a  patient  unsuitable 
for  a  test  expeiiment ;  and  the  presence  of  "mitral 

*  Op.  cit. 


Chap.  IV.]        Albuminuria  from  Food.  409 

incompetence  "  would  give  so  great  a  tendency  to 
venous  hypersemia,  that  the  occurrence  of  slight  tem- 
porary albuminuria  might  be  readily  provoked. 

The  occurrence  of  temporary  albuminuria  under 
circumstances  like  these  has  been  explained  by  the 
suggestion  that  the  blood,  becoming  surcharged  with 
albumen,  some  of  the  excess  escapes  by  the  kidneys  ; 
but  may  not  the  true  explanation  be  that  the  inges- 
tion of  so  large  an  excess  of  albuminous  material 
throws  upon  the  kidney  such  an  excess  of  nitrogenous 
waste  (to  be  excreted),  that  a  temporary  functional 
hypenemia  of  the  kidneys  is  excited,  and  that  this 
leads  to  a  slight  escape  of  albumen  from  the  blood  1 
It  appears  to  us  that  this  is  a  sound  physiological 
explanation  of  what  is  observed  to  occur,  and  ac- 
counts for  its  occurring  in  feeble  or  disordered  con- 
stitutions, and  not  in  the  perfectly  sound  and  vigorous. 

Sir  T.  Grainger  Stewart  also  tested  the  eftects  of 
some  other  articles  of  food,  as  cheese  and  walnuts,  and 
came  to  the  conclusion  that,  although  "particular 
articles  of  diet  induce  albuminuria  in  some  people, 
yet  the  quantity  of  albumen  is  usually  minute,  and 
it  has  little  tendency  to  persist  after  the  resumption 
of  ordinary  food." 

Pettenkofer's  and  Voit's  observations  *  convinced 
these  physiologists  that  albuminuria  was  never  caused 
solely  by  excess  of  nitrogenous  food.  Voit  gave  a 
dog  weighing  35  kilogrammes  2,600  grammes  of  meat 
in  twenty-four  hours,  and  found  not  the  least  trace  of 
albumen  in  the  urine;  yet  the  animal  had  absorbed 
nearly  six  times  the  amount  of  dry  albumen  con- 
tained in  the  fluids  of  its  body. 

Professor  Oertel  also  experimented  on  the  effects 
of  the  ingestion  of  egg-albumen.  He  gave  to  his  dog, 
weighing  only  7|  kilogrammes,  the  whites  of  20  eggs 
in  24  hours  by  the  stomach,  and  after  various  trials 
he  never  found  albumen  in  the  urine.  He  also  gave 
to  one  of  his  patients  affected  with  heart  disease, 
besides  150  grammes  (about  12|^  oz.)   of  meat,  190 

*  Quoted  by  G.  S6e,  "  Du  Regime  Alimentaire,"  p.  705. 


4IO  Food  in  Disease.  [Panii. 

grammes  (about  7  oz.)  of  bread,  and  200  grammes 
(rather  more  than  7  oz.)  of  vegetables,  six  raw  eggs 
daily  for  12  days — i.e.  72  eggs  altogether — containing 
4G0  grammes  of  dry  albumen,  without  finding  a  trace 
of  albumen  in  his  urine.  He  obtained,  moreover,  the 
same  negative  result  with  a  patient  who  ate,  on  an 
average,  six  boiled  eggs  daily. 

It  is,  then,  safe  to  conclude  that  the  occasionally 
observed  occurrence  of  albuminuria  as  a  result  of  the 
ingestion  of  albuminous  food  in  excess  is  an  accidental 
peculiarity  or  idiosyncrasy,  and  not  an  ordinary 
physiological  phenomenon. 

With  regard,  however,  to  diet  in  albuminuria 
when  connected  with  existing  renal  disease,  there  is, 
as  has  already  been  said,  an  almost  general  consent 
that  richly-nitrogenised  food  is  distinctly  prejudicial, 
and  more  especially  so  if  it  consists  of  brown  meats, 
of  eggs,  or  of  highly-spiced  food. 

Sir  T.  Grainger  Stewart  has,  nevertheless,  expressed 
his  belief  that  in  the  cirrhotic  form  of  Bright's  disease 
diet  is  a  less  important  element  in  treatment  than  in 
cases  of  tubular  inflammation ;  and  he  gives  the  par- 
ticulars of  cases  in  which  he  ordered  eight  raw  eggs 
daily  in  addition  to  the  usual  "low  diet,"  without 
causing  any  material  change  in  the  secretion.* 

But,  as  Dujardin-Beaumetz  has  well  pointed  out, 
in  dealing  with  cases  of  advanced  Bright's  disease,  it 
is  not  so  much  the  quantity  of  albumen  that  appears 
in  the  urine  that  should  be  our  chief  concern,  but 
rather  the  extent  of  the  renal  changes,  and  the  con- 
sequent retention  of  products  of  nitrogenous  waste  in 
the  system ;  and  it  is  to  avoid  or  diminish  the  risks 
of  this  intoxication  with  urinary  excreta  that  our 
dietetic  rules  should  be  directed.! 

The  clear  indication,  then,  is  to  administer  food 
which  is  found  to  be  readily  assimilable,  and  which 
will  least  tax  the  digestive  functions,  and  at  the  same 
time  furnish  the  smallest  amount  of  nitrogenous  waste 
calling  for  elimination  by  the  damaged  kidneys. 
*  Op.  cit,  p.  206.  t  "  L'Hygi^ne  Alimentaire,"  p.  188. 


Chap.  IV.]     Milk  Diet  IN  Albuminuria.  411 

To  fulfil  this  indication  it  has  been  proposed  to 
restrict  the  food  of  those  suffering  from  both  acute 
and  chronic  Bright's  disease  exclusively  or  almost 
exclusively  to  milk  ;  and  it  is  certain  that  some  of 
the  most  remarkable  and  best  results  in  the  treat- 
ment of  these  cases  have  been  obtained  from  a 
strict  adherence  to  milk  diet—the  regime  lacU  of 
French  authors.  In  cases  in  which  this  plan  of 
feeding  has  been  well  borne,  it  has  been  observed 
that  the  flow  of  urine  has  increased,  the  excretion 
of  albumen  diminished,  the  amount  of  urea  and 
extractives  has  been  augmented,  and  the  anasarca 
has  disappeared. 

But  great  practical  difiiculties  are  often  en- 
countered in  procuring  the  adoption  of  this  method 
by  the  patients  themselves,  and  in  not  a  few  cases  a 
diet  consisting  exclusively,  or  even  largely,  of  milk  is 
not  well  tolerated. 

It  is,  however,  quite  established  that  an  ex- 
clusively milk  diet  can  completely  supply  all  that  is 
needed  to  repair  the  nutritive  wants  of  the  organism. 

As  a  food  for  adults  milk  is  defective  in  the 
amount  of  carbo-hydrates  which  it  contains,  and 
which  is  required  in  the  adult  body  for  the  develop- 
ment of  animal  heat  and  muscular  energy. 

According  to  Pettenkofer's  and  Voit's  calculation, 
the  daily  ration  for  an  adult  should  contain — 

137  grammes  of  dry  albumen ; 
117        „        of  fat; 
and  352        „        of  carbo-hydrates. 

The  invalid  who  takes  little  exercise  and  expends 
little  in  muscular  exertion  would  require  somewhat 
less,  and  it  is  reckoned  that  fiom  5  to  7  pints  (i.e. 
100  to  140  oz.)  of  milk  daily  will  be  sufficient  for  all 
the  requirements  of  an  adult. 

Seven  pints  of  milk  are  estimated  to  contain 

216  grammes  (about  7i  oz.)  of  albumen  and  casein; 
172         „         (     „      6'    „  )  of  butter; 

and  101         „         (    „     b\  „  )  of  lactose. 


412  Food  in  Disease.  [Partii. 

If  this  quantity  falls  sliort  in  the  relative  propor- 
tion of  carbo-hydrates,  it  makes  up  for  this  by  the 
increased  proportion  of  fat  and  albuminates  contained 
in  it. 

Milk  is  also  rich  in  chlorides  and  phosphates,  salts 
essential  to  the  due  nutrition  of  the  tissues.  It  has 
been  suggested  that  the  other  saline  ingredients  con- 
tained in  milk  may  exercise  a  diuretic  action,  but  it 
seems  more  probable  that  the  increase  in  the  flow  of 
urine  observed  to  accompany  an  exclusively  milk  diet 
is  due  to  the  quantity  of  water  ingested.  It  has 
been  maintained  by  G.  See  and  Dujardin-Beaumetz 
that  lactose  is  an  active  diuretic. 

The  mode  of  applying  this  exclusively  milk  diet  is 
as  follows : — 

If  the  patient's  stomach  will  bear  the  sudden 
suppression  of  all  other  kinds  of  food,  the  full  quantity 
of  milk  may  be  at  once  taken  daily ;  but  if  the 
stomach  shows  less  tolerance  of  the  change,  it  should 
be  made  more  gradually,  and  half  a  glass  or  a  glass  of 
milk  should  be  taken  at  suitable  intervals,  and  other 
kinds  of  food  slowly  and  by  degrees  replaced  by  it. 

The  milk  should  be  as  fresh  from  the  cow  as  it 
is  possible  to  obtain  it,  and  drunk  at  the  ordinary 
temperature,  not  boiled,  and  with  no  flavouring  or 
addition  whatever.  It  is  better  to  take  it  in  small  or 
moderate  quantities  at  short  intervals — a  glass  (6  oz.) 
every  hour  during  the  day,  and  two  glasses  on  getting 
up  and  on  going  to  bed;  or  when  it  is  inconvenient  to 
take  it  so  often,  two  glasses  may  be  taken  every  two 
hours.  When  the  patient  is  restricted  entirely  to 
milk,  it  must  be  remembered  that  he  will  require  to 
take  from  18  to  24  glasses  of  6  oz.  each  in  the  twenty- 
four  hours. 

It  is  very  important  that  at  the  commencement 
of  this  diet  the  doses  should  be  small ;  dislike  of  the 
remedy  and  digestive  troubles  are  much  more  likely 
to  occur  and  interfere  with  the  success  of  the  treat- 
ment if  the  patient  is  allowed  to  begin  by  taking 
large  quantities  at  a  time. 


Chap.  IV.]      Milk  Diet  in  Albuminuria.  413 

If  diarrlicea  should  occur,  it  is  a  sign  that  the 
milk  is  not  digested,  and  the  diet  must  be  altered  or 
modified  ;  a  reduction  in  the  quantity  may  be  all  that 
is  needed. 

As  soon  as  the  tolerance  of  this  milk  diet  is 
established,  and  the  patient  is  able  to  take  from  five 
to  seven  pints  a  day,  an  inconvenience  arises  in  the 
form  of  obstinate  constipation ;  and,  at  the  same 
time,  the  patient  often  complains  of  an  unpleasant 
taste  in  the  mouth  and  a  dirty  tongue. 

The  state  of  the  mouth  may  be  improved  by  sip- 
ping a  little  soda-  or  seltzer-water  after  each  glass  of 
milk ;  and  the  constipation  must  be  encountered  by 
some  suitable  aperient — a  little  Gregory's  powder  or 
compound  liquorice  powder,  or  citrate  of  magnesia 
or  a  capsule  of  castor-oil,  or  a  teaspoonful  of 
Carlsbad  salts,  or  an  aperient  enema ;  either  of 
these  may  be  taken,  according  to  the  discretion 
of  the  medical  attendant  or  the  inclination  of  the 
patient. 

In  veiy  troublesome  cases  of  constipation,  an 
addition  to  the  daily  diet  of  a  few  stewed  prunes  or 
the  pulp  of  one  or  two  baked  apples  may  be  per- 
mitted. 

The  body-weight  usually  diminishes  somewhat 
during  this  treatment ;  the  urinary  secretion  is  often 
increased  to  a  remarkjible  extent,  and  this  diuresis 
is  generally  accompanied  by  a  disappearance  of 
dropsy,  if  it  exists. 

The  abundant  urine  is  pale,  clear,  with  a  peculiar 
greenish-yellow  reflection,  said  to  be  characteristic  of 
the  milk  diet ;  usually  of  low  specific  gravity,  on 
account  of  the  quantity  excreted,  and  of  diminished 
acidity  ;  the  amount  of  albumen  excreted  will  usually 
be  observed  to  dimini-sh  gradually  from  day  to  day, 
while  the  proportion  of  urea  and  salts  is  progressively 
increased. 

It  has  been  noticed  that  during  the  night,  when 
the  ingestion  of  milk  is  necessarily  interrupted, 
the  urine   is   passed   in   less   quantity  and  is  more 


414  Food  in  Disease.  [Partii. 

albuminous.  Jaccoud,  therefore,  recommends  that  the 
patient  should  take  advantage  of  any  chance  wakings 
during  the  night  to  drink  a  few  doses  of  milk,  so  as 
to  keep  the  urinary  secretion  constantly  under  its 
intluence. 

The  period  during  which  the  treatment  should  be 
maintained  cannot  be  fixed  with  any  strictness.  It 
must  depend  upon  the  nature  of  the  case  and  the 
progress  of  the  patient. 

If  we  are  treating  a  case  of  acute  nephritis,  and 
have  adopted  the  exclusively  milk  diet  from  the  com- 
mencement, three  or  four  weeks  may  suffice  to  get  rid 
of  the  albuminuria,  and  we  may  slowly  and  gradually 
return  to  the  ordinary  diet. 

In  chronic  parenchymatous  nephritis  (inflamma- 
tion of  the  tubules),  the  result  of  treatment  will 
depend  upon  the  age  of  the  patient  and  the  duration 
and  extent  of  the  kidney  lesions. 

In  advanced  cases,  where  cure  is  not  possible, 
considerable  amelioration  in  the  general  condition  of 
the  patient  may  constantly  be  observed,  together  with 
an  increased  flow  of  urine,  disappearance  of  dropsy,  a 
steady  diminution,  little  by  little,  of  the  amount  of 
albumen,  which,  although  it  may  not  entirely  dis- 
appear, at  the  end  of  six  or  eight  weeks  will  be 
reduced  to  a  minimum.  The  kidney  lesions  are 
irreparable,  but  the  milk  diet  has  lessened,  in  a  great 
measure,  the  excretion  of  albumen,  and  has  restored 
a  due  elimination  of  the  nitrogenous  and  other 
urinary  excreta. 

In  cases  of  cirrhotic  or  interstitial  nephritis  (gouty 
contracted  kidney),  an  exclusively  milk  diet  is  less 
urgently  indicated.  When,  however,  the  cardiac 
compensation  begins  to  fail,  and  symptoms  of  uryemia 
are  threatening,  then  great  advantage  may  follow  the 
adoption  of  this  mode  of  treatment. 

We  are  in  ignorance  at  present  as  to  the  precise 
manner  in  which  the  milk  acts  on  the  organism  or  on 
the  diseased  kidneys  so  as  to  produce  the  beneficial 
results  observed.  


Chap,  IV.]  Diet  IN  Albuminuria.  415 

In  those  cases  in  which  an  exclusively  milk  diet 
is  badly  borne  or  absolutely  rejected  by  the  patient, 
we  must  fall  back  on  some  other  method  of  feeding. 

We  should,  in  the  first  place,  endeavour  to  induce 
the  patient  to  accept  a  modified  milk  diet,  and  supply 
him  with  dishes  largely  composed  of  milk,  but  which 
have  the  advantage  of  agreeable  flavouring,  without 
which  food  of  all  kinds  is  so  repugnant  to  many. 

Milk  may  be  made  the  basis  of  soups,  to  which 
various  vegetable  flavouring  substances  may  be 
added,  as  onions,  celery,  and  the  usual  aromatic 
herbs  commonly  employed  for  such  purposes,  together 
with  a  little  salt  and  pepper ;  fragments  of  toasted 
bread  may  be  served  with  these  milk  soups.  Arrow- 
root, tapioca,  rice,  and  vermicelli  may  be  used  to 
thicken  milk,  and  a  little  grated  lemon-peel  or  cloves 
or  nutmeg  may  be  used  to  flavour  foods  thus  made ; 
or  a  small  quantity  of  fruit  jelly,  such  as  red-currant 
jelly,  may  be  eaten  therewith. 

On  leaving  off"  the  exclusively  milk  diet  the 
patient  should  be  permitted,  by  slow  degrees  only,  to 
return  to  the  ordinary  diet. 

At  first  a  little  arrowroot,  tapioca,  or  rice  should 
be  substituted  for  a  portion  of  the  milk  ;  then  a  little 
fish,  chicken,  or  other  white  meat,  and  a  little  green 
vegetable,  cooked  fruit,  and  a  small  quantity  of  good 
sound  Bordeaux  wine,  mixed  with  seltzer-water,  may 
be  taken  with  the  midday  meal. 

Should  the  attempt  to  return  to  a  mixed  diet  be 
attended  with  an  increase  in  the  quantity  of  albumen 
excreted,  the  exclusively  milk  diet  must  again  be 
resorted  to. 

It  must,  of  course,  be  borne  in  mind  that  an  irre- 
parably damaged  kidney  cannot  be  made  structurally 
sound  by  milk  diet  or  by  any  other  remedy  ;  and  in 
such  cases,  after  the  albumen  has  been  reduced  to  a 
minimum  by  the  milk  diet,  a  return  to  a  carefully- 
arranged  mixed  diet  may  not  only  be  justiflable,  but 
advantageous. 

Oertel,  Grainger  Stewart,  and  others  have  shown 


4i6  Food  in  Disease.  (Partii. 

that  in  many  cases  such  a  diet  rich  in  albumen  is 
well  tolerated,  and  not  attended  with  any  notable 
increase  in  the  amount  of  albumen  excreted  in  the 
urine. 

It  is  in  acute  cases,  and  especially  in  those  cases 
which  seem  to  be  passing  from  acute  to  chronic,  and 
before  the  structure  of  the  kidneys  has  been  hope- 
lessly damaged  by  inflammatory  and  degenerative 
changes — it  is  in  such  cases  as  these  that  the  exclu- 
sively milk  diet  is  attended  with  such  brilliant 
results. 

When  the  milk  diet  is  inadmissible,  we  have  then 
to  consider  what  is  the  best  alternative. 

It  has  already  been  pointed  out  that  the  subjects 
of  albuminuria  must  carefully  avoid  any  excess  of 
nitrogenous  food.  Senator  recommends  that  animal 
flesh  should  be  altogether  avoided,  or  limited  to, 
at  most,  a  little  white  meat,  while  all  kinds  of  veget- 
ables and  fats  are  permissible.  Dujardin-Beaumetz 
also  testifies  that  he  has  obtained  excellent  results  by 
restricting  patients  with  albuminuria  to  vegetable 
food.  Farinaceous  food,  fresh  vegetables,  and  fruit, 
together  with  milk,  butter,  cream,  and  other  fats, 
afford  all  that  can  be  needed  for  the  nutrition  of 
the  body. 

Dujardin-Beaumetz  commends  the  onion,  espe- 
cially, as  an  addition  to  soups  ;  and  he  states  that 
when  he  has  found  his  albuminuria  patients  unwilling 
to  relinquish  meat,  pork  has  appeared  to  him  to  in- 
crease the  amount  of  albumen  excreted  less  than 
other  meats,  and  he  is,  therefore,  in  the  habit  of 
recommending  them  either  ham  or  cold  roast  pork, 
and  the  fat  in  particular.  He  differs  from  Senator  in 
not  thinking  well  of  fish  in  these  cases ;  he  believes 
it  increases  notably  the  amount  of  albumen  in  the 
urine.  As  cheese  is  a  highly  albuminous  food  it 
sliould  be  avoided  altogether,  or  taken  only  in  very 
small  quantity. 

As  a  beverage,  he  prefers  milk,  so  long  as  the 
patient   can   tolerate   it ;    all   spirits   and  undiluted 


cnap.  IV.]  Diet  IN  Albuminuria.  417 

wines,  and  all  kinds  of  beer  he  forbids  entirely ;  lie 
allows,  in  certain  cases,  a  small  quantity  of  wine, 
especially  tannin  wine  (St.  Raphael),  mixed  with  the 
alkaline  waters  of  Vals  or  Vichy. 

Animal  broths,  beef-tea,  and  meat  extractives  are 
rarely  desirable  in  the  diet  of  nephritic  patients.  Their 
mode  of  preparation  leads  to  the  extraction  of  all  the 
possible  toxins  there  may  be  in  the  meat,  and  these 
may  irritate  the  kidneys.  They  may  also  favour  the 
occui-rence  of  urseniia. 

Semmola  of  Naples  has  advocated  the  habitual 
use  of  the  following  drink  for  patients  with  Bright's 
disease : — 

Sodium  iodide ...  ...         ...         ...  15  grains. 

„      phosphate  30      „ 

„       chloride  90       „ 

Drinking  water  36  oz. 

He  recommends  that  this  should  be  drunk  daily, 
either  alone  or  mixed  with  milk,  and  states  that  he 
has  obtained  the  best  effects  from  its  use. 

There  has  recently  been  manifested  something  of 
the  nature  of  a  revolt  against  the  excessive  advocacy 
of  a  milk  diet  in  chronic  Bright's  disease.  It  has 
been  said  that  such  cases  do  better  on  a  "  full "  diet. 
This  we  think  is  leaning  too  much  to  the  other 
extreme.  Inferences  from  observation  of  hospital 
patients  alone  must  be  received  with  much  caution, 
for  this  class  detest  a  milk  diet.  Their  only  idea  of 
a  sufficient  diet  is  an  abundance  of  animal  flesh,  and 
it  is  quite  possible  that  milk  diet  fails  to  produce  good 
results  on  them  because  of  their  intense  and  un- 
reasoning distaste  for  it ;  but  there  can  be  no  doubt 
whatever  that  remarkably  good  results  have  been 
obtained,  in  properly  selected  cases  in  private  practice, 
by  the  adoption  of  a  milk  diet 

Few  physicians  can  have  had  a  larger  experience 
in  these  cases  than  Sir  Geo.  Johnson,  and  he  testifies 
that  "  in  some  cases,  under  the  influence  of  an  exclusive 
milk  diet,  albuminuria,  even  of  long  duration,  s[)eedily 

B  B 


41 8  Food  in  Disease.  [Part  ii. 

passes  away."  He  mentions  the  case  of  a  lady  who 
had  had  postscarlatinal  albuminuria  for  fifteen 
months,  who  completely  and  rapidly  recovered  on  an 
exclusively  milk  diet.  He  refers  also  to  the  case  of  a 
patient,  55  years  of  age,  with  "  chronic  gouty  albu- 
minuria," whom  he  advised  to  tiy  an  exclusive  milk 
diet.  "  This  he  continued  for  more  than  five  years, 
taking  about  a  gallon  of  skimmed  milk  daily.  On 
this  simple  diet  his  health  greatly  improved,  and  he 
frequently  reported  himself  as  feeling  quite  well, 
though  a  trace  of  albumen  still  remained.  After 
five  years  on  milk  diet  he  gradually  went  back  to 
solid  food,  without  alcoholic  stimulants,  and  I  have 
heard  of  him  quite  recently  as  remaining  in  good 
health."* 

The  observations  on  this  subject  put  forward  by 
Professor  Andrew  H.  Smith,  M.D.,  of  New  York, 
are  so  much  to  the  point  that  we  venture  to  quote 
them  here  t : — 

"  The  only  true  standai'd  (of  a  suitable  diet)  is  to 
be  found  in  the  general  condition  of  the  patient.  If 
on  changing  from  a  non-nitrogenous  diet  to  a  nitro- 
genous one  we  find  a  general  improvement  in  the 
patient's  condition,  it  is  an  evidence  that  the  change 
was  beneficial,  no  matter  if  the  albumen  fills  a  larger 
portion  of  the  test  tube.  On  the  other  hand,  if  we 
cut  off  a  large  proportion  of  animal  food  from  the 
diet,  and  our  patient  grows  more  dyspeptic,  weaker, 
more  anaemic,  more  dropsical,  it  is  nothing  to  the 
point  that  only  one-half  or  one-third  of  the  former 
quantity  of  albumen  is  found  in  the  urine  ;  the  change 
has  done  harm,  and  the  sooner  we  change  back  again 
the  better. 

"We  should,  above  all  things,  seek  that  diet  for  the 
patient  which  he  can  best  digest  and  assimilate,  for 
we  may  rest  assured  that  the  products  of  faulty 
digestion   and  assimilation  will   irritate   the  kidneys 

*  "Medical  Lectures  and  Essays,"  p.  764. 
t  "Hare's  System  of  Practical  Therapeutics,"  vol.  iii.,   p. 
49.     1892. 


Chap.  IV.  Diet  IN  Albuminuria.  419 

more  than  any  amount  of  normal  material  they  may 
be  called  upon  to  eliminate,  while,  at  the  same  time, 
the  general  system  will  sutler  from  lack  of  support." 

In  conclusion,  we  would  call  attention  to  the 
following  interesting  observations  and  conclusions  as 
to  the  influence  of  ditferent  kinds  of  diet  in  chronic 
Bright's  disease  made  by  Dr.  Nikolas  S.  Zasiadko, 
of  St.  Petersburg,*  who  has  carried  out  a  series  of 
comparative  clinical  experiments  on  ten  patients 
sufTering  from  chronic  nephritis,  his  object  being  to 
elucidate  the  influence  of  a  vegetable,  animal,  and 
mixed  dietary  on  the  course  of  the  disease.  In 
each  instance  the  experiment  lasted  thirty  days, 
during  the  first  ten  of  which  the  patient  was  kept 
on  a  vegetable  diet,  during  the  second  ten  on  an 
animal  one  (with  the  addition  of  some  bread),  and 
during  the  third  period  on  a  mixed  diet.  It  was 
found  that  (1)  under  the  influence  of  vegetable  food 
the  daily  amount  of  albumen  in  the  urine  markedly 
decreased  ;  the  arterial  tension  sank,  dropsy  consider- 
ably increased  ;  the  pulse  became  slower,  weaker,  and 
more  easily  compressible ;  the  appetite  was  gradually 
lost ;  the  general  state  grew  worse,  the  patient 
becoming  weaker,  apathetic,  etc.  (2)  Under  the 
influence  of  animal  food  the  daily  quantity  of  albu- 
men in  the  urine  markedly  increased  ;  the  arterial 
tension  rose  ;  cedematous  swellings  were  diminished  ; 
the  pulse  became  more  frequent  and  fuller ;  the  body 
weight  decreased  pari  passu  with  the  disappearance 
of  dropsy ;  the  daily  amount  of  the  urine,  the  propor- 
tion of  its  solid  constituents,  and  specific  gravity 
increased ;  the  general  state  improved,  the  patient 
growing  stronger,  more  cheerful,  etc.  (3)  A  mixed 
diet  stood  midway  in  its  eflects,  but  came  nearer  to 
the  animal  one  in  regard  to  its  influence  on  albu- 
minuria. (4)  The  proportion  of  albumen  in  the  urine 
per  se  affords  no  criterion  for  determining  the  gravity 
of  the  renal  lesion.  The  patient's  dietary  should  also 
be  always  taken  into  consideration,  as  the  ingestion 
*  Vratch,  No.  39,  1890,  p.  880. 
BB  2 


420  Food  in  Disease.  [Pan  ii. 

of  an  abundant  proteid  food  raises  the  said  proportion 
by  causing  a  "  dietetic  albuminuria,"  which  quickly 
disappears  on  decreasing  the  quantity  of  food  proteids. 
(5)  In  view  of  the  fact  that  chronic  Bright's  disease 
(a)  consists  in  a  general  affection  of  the  vascular 
system  and  not  of  the  kidney  alone ;  and  (6)  is 
accompanied  by  a  profound  alteration  of  the  blood, 
characterised  by  an  increased  proportion  of  water  and 
a  decreased  proportion  of  proteids,  haemoglobin,  and 
morphological  elements,  rational  treatment  should 
consist  in  raising  the  patient's  general  nutrition  by 
means  of  a  liberal  diet  abounding  in  proteids.  Such 
diet  does  not  give  rise  either  to  any  renal  irritation 
(heematuria,  hsemoglobinuria,  exacerbation  of  the  renal 
process)  or  to  ursemia.  (6)  The  best  dietary  for 
chronic  Bright's  disease  is  a  mixed  one.  In  inter- 
stitial nephritis,  accompanied  by  general  weakness, 
animal  should  predominate  over  vegetable  food ;  in 
parenchymatous  nephritis  with  profuse  albuminuria, 
vegetable  food  with  milk  should  be  in  relative  excess. 
(7)  Boasted  or  cooked  Italian  chestnuts  markedly 
diminish  the  proportion  of  albumen  in  the  urine, 
owing  to  their  containing  tannic  acid. 

We  give  these  conclusions  for  what  they  are 
worth,  and  they  must  not  be  accepted  unconditionally, 
but  rather  as  suggestive  of  further  observations  in 
the  same  direction. 


421 


CHAPTER  V. 

DIET   IN   GOUT   AND    CALCULOUS    DISORDERS. 

If  gout  is,  as  we  have  maintained  elsewhere,*  mainly 
due  to  disturbed  retrograde  metamorphosis  of  the 
nitrogenous  constituents  of  food,  it  follows  that  it 
must  be  a  disease  greatly  under  the  control  and 
influence  of  diet. 

Closely  related  to  those  morbid  disturbances  in 
the  metabolism  of  niti-ogenous  food  which  give  rise  to 
the  well-known  manifestations  of  gout  are  certain 
states  of  the  blood  and  other  fluids,  which,  owing  to 
the  abnormal  amount  or  insoluble  nature  of  the 
excrementitious  solids  contained  in  them,  or  to  some 
other  morbid,  physical,  or  chemical  change  in  these 
fluids,  tend  to  deposit  some  of  their  solid  constituents 
within  the  body.  In  the  more  common  forms  of  gout 
this  tendency  is  shown  in  the  deposition  of  insoluble 
urates  in  and  around  the  joints.  In  what  are  termed 
gravel  and  calculous  disorders  we  find  solid  deposits 
occurring  in  the  urinary  passages ;  and  in  this  con- 
nection we  may  also  consider  the  analogous  deposits 
which  occur  in  the  biliary  tracts. 

From  a  dietetic  point  of  view  we  shall  find  it 
convenient  to  consider  these  related  conditions  to- 
gether, as  they  are  capable  of  being  influenced  and 
controlled  by  much  the  same  dietetic  rules. 

Too  much  stress  has  been  laid  on  insufficient 
bodily  exercise  as  a  princi[)al  cause  of  the  conditions 
adverted  to,  when  associated  with  too  liberal  an 
animal  dietary ;  for  a  careful  examination  of  the 
habits  of  life  of  those  who  sutfer  from  these  afiiections 

*  "The  Therapeutics  of   the  Uric-Acid  Diathesis." — British 
Medical  Journal,  January  7th  and  14th,  1888. 


422  Food  in  Disease.  [Panii. 

will  lead  to  the  discovery  that  very  many  are  persons 
of  exceedingly  active  habits,  who  are  at  the  same 
time  large  feeders.  Indeed,  their  habits  of  muscular 
exercise,  as  in  hunting,  racket-playing,  etc.,  are  often 
attended  with  profuse  perspiration,  and  the  exces- 
sive loss  of  fluid  from  the  surface  by  cutaneous 
transpiration,  together  with  a  large  consumption  of 
nitrogenous  and  other  food,  and  the  production  of 
an  excess  of  niti'ogenous  waste,  combines  to  produce 
a  relative  excess  of  solid  matter  in  the  blood  and  in 
the  urinary  and  biliary  excretions,  and  this  directly 
favours  the  deposition  of  gravel  and  calculi.  So 
that  it  is  necessary  to  seek  the  remedy,  in  many 
instances,  rather  in  a  reduction  or  modification  of 
the  food  than  in  an  increase  of  bodily  activity. 
And  there  are  instances  in  which  it  may  even  be 
advisable  to  restrain,  rather  than  promote,  the  latter, 
especially  when  we  desire  to  lessen  the  amount  of 
nitrogenous  waste  added  to  the  blood. 

There  are,  however,  it  must  be  admitted,  certain 
rare  forms  and  instances  of  these  maladies  which 
appear  to  have  their  origin  in  a  deeply-rooted,  often 
(but  not  always)  inherited  vice  of  nutrition,  or  per- 
verted metamorphosis,  in  which  these  morbid  dis- 
turbances in  the  metabolism  of  nitrogenous  food  and 
waste  are  almost  beyond  the  reach  of  remedy  either 
by  food  or  medicine.  I  refer  especially  to  those, 
happily  somewhat  rare,  cases  of  crippling  gout  in 
which  the  digital  articulations  of  both  upper  and 
lower  extremities  become  the  seat  of  large  and 
multiple  deposits  of  urate  of  soda,  often  producing 
great  chronic  deformity  and  helplessness.  Such  cases 
have  not,  perhaps,  been  so  exhaustively  studied  as 
they  deserve  to  be,  but,  so  far  as  our  own  observations 
have  extended, they  are  more  commonly  found  amongst 
the  examples  of  what  has  been  called  "  poor  man's 
gout " — i.e.,  cases  in  which  the  general  nutrition  is 
manifestly  defective,  and  in  which  there  has  been  no 
history  either  of  generous  living  or  of  deficient 
exercise. 


Chap,  v.]  Nature  of  Gout.  423 

It  is  also  necessary  to  bear  in  mind  at  the  outset 
tliat  gout  is  a  general,  constitutional,  chronic  malady, 
and  that  the  attacks  of  acute  arthritis,  so  commonly 
regarded  as  the  characteristic  manifestations  of  gout, 
may  be  entirely  absent,  and,  even  when  present, 
may  constitute  by  no  means  the  most  serious  part  of 
the  morbid  phenomena  with  which  the  gouty  person 
is  afflicted. 

We  must  also,  and  more  especially,  look  to  disturb- 
ances in  the  assimilative  functions,  to  disorders  of 
digestion,  stomachic  and  intestinal,  to  functional  de- 
rangements of  the  circulatory  and  nervous  systems, 
to  changes  in  the  coats  of  the  superficial  arteries,  and 
])articu]arly  to  the  physical  and  chemical  characters  of 
the  urine,  as  presenting  important  indications  of  the 
existence  of  the  gouty  state — i.e.,  of  the  presence  of 
uriciemia,  or  other  allied  morbid  states  of  the  blood, 
calling  for  dietetic  treatment. 

If  we  accustom  oursel  ves  to  look  at  gout  with  this 
wider  and  more  general  conception  of  its  nature  in 
our  minds,  we  shall  not  fail  to  recognise  its  influential 
presence  in  connection  with  many  vague  morbid  states 
often  greatly  misunderstood. 

You  will  find  in  young  children,*  in  the  nurseiy 
even,  but  more  commonly  at  school,  who  happen  to 
be  the  offspring  of  intensely  gouty  parents,  severe 
headaches,  troublesome  neuralgias,  chronic  skin  affec- 
tions, attacks  of  asthma,  and  various  other  disturb- 
ances of  health  connected  with  the  inheritance  of  the 
gouty  constitution,  and  dependent  on  morbid  states  of 
the  blood  which  are  capable  of  being  modified  and 
ameliorated  by  diet. 

In  women,  and  not  only  those  who  have  passed 
the  climacteric,  but  also  in  young  women — although, 
no  doubt,  the  eliminative  character  of  the  menstrual 
functions  saves  them  from  much  of  the  goutiness  of 
the   male  sex — it  will   be   found  that  many  of  tho 

*  G.  See  has  stated  tliat  out  of  200  gouty  patients  he  found  30 
per  cent,  under  20  years  of  age.  "Du  Kt^gimc  Alimentaire." 
p.  429. 


424  Food  in  Disease.  [Panii. 

vague  afiections  of  the  nervous  system,  which  are 
commonly  associated  with  those  ill-comprehended 
))athological  states  denominated  "  Hysteria  " — many 
of  these  troublesome,  although  apparently  trivial, 
disturbances  of  health  are  really  of  gouty  origin. 

Three  facts  have  cei'tainly  been  established  (mainly 
by  the  labours  of  Garrod)  in  connection  with  gout : 
1st,  that  in  the  gouty  there  is  an  excess  of  uric  acid 
in  the  blood ;  2nd,  that  during  an  attack  of  gout 
there  is  a  diminution  of  uric  acid  in  the  urine  often 
by  one  half;  and  3rd,  that  at  the  end  of  an  attack 
there  is  an  excess  of  uric  acid  in  the  urine.  And 
these  facts  are  interpreted  as  meaning  that  before  and 
especially  during  an  attack  the  blood  is  surcharged 
with  uric  acid,  and  that  at  the  end  of  the  i)aroxysm 
this  excess  is  discharged  in  the  urine,  and  the 
patient  is,  for  a  time  at  any  rate,  set  free  from  his 
uriciBmia. 

But  although  it  is  generally  admitted  that  in  gout 
there  is  an  excess  of  uric  acid  in  the  blood,  it  is  not 
certain  whether  this  is  due  to  an  abnormally  large 
productioji  of  uric  acid  in  the  body,  or  simply  to  an 
abnormal  retention  of  it  there. 

The  deposition  of  uric  acid  in  the  bodies  of  the 
gouty  may  be  simjjly  dependent  on  a  diminished 
faculty  on  the  part  of  their  fluids  to  hold  the  salts  of 
uric  acid  in  solution ;  and  this  inability  to  hold  the 
uric  acid  salts  in  solution  may  depend  on  an  abnorm- 
a^y  acid  state,  or,  what  is  the  same  thing,  a  diminished 
aiM,linity  of  those  fluids. 

It  was  held,  and  is  still  held  by  many,  that  uric 
acid  represents  a  low  grade  of  oxidation  of  the  nitro- 
genous waste  necessarily  produced  in  the  metabolism 
of  albuminous  foods,  and  that  when  such  foods  are 
taken  in  great  excess  they  cannot  be  completely 
oxidised  into  urea,  which  is  very  soluble  and  readily 
eliminated ;  consequently,  an  abnormally  large  pro- 
portion is  converted  into  uric  acid,  representing 
a  lower  grade  of  oxidation,  and  the  salts  of  this  acid, 
being  very  insoluble,  are  less  readily  eliuiinated,  and 


Chap,  v.]     Dietetic  Indications  in  Gout.         425 

therefore  tend  to  accumulate  in  the  blood  and  to  be 
deposited  within  tlic  body. 

This  view,  of  course,  traces  gout  to  an  excess  of 
nitrogenous  ingesta.  But  if  we  refer  gout  to  a 
deficient  alkalinity  and  diminished  solvent  power  of 
the  fluids,  however  brought  about,  we  get  a  wider,  and 
perhaps  a  truer,  grasp  of  the  causation  of  the  disease; 
for  while  this  view  recognises  the  causative  influence 
of  an  excess  of  albuminates  in  the  food,  it  does  not 
exclude  other  causes,  which  we  must  take  into  con- 
sideration in  explaining  the  occurrence  of  this  disease 
in  many  persons. 

It  has  been  noticed  (Voit  and  Hoffmann)  that 
strongly  acid  urines  show  a  tendency  to  deposit  sedi- 
ments, and  it  has  been  pointed  out  that  in  the 
metabolism  of  albumen  the  sulphur  and  phosphorus 
contained  iu  it  become  cojiverted  into  sulphuric  and 
phosphoric  acids,  all  of  which  may  not  be  completely 
neutralised,  and  may  be  sufficiently  in  excess  to 
augment  the  acidity  of  the  urine ;  so  that  an  excess 
of  albuminous  food  may  contribute  to  the  deposition 
of  insoluble  salts  of  uric  acid  by  diminishing  tlie 
alkalinity  of  the  fluids,  which,  indeed,  it  is  known  to 
do.  In  the  same  way,  those  dyspeptic  conditions, 
which  are  so  common  in  some  gouty  persons  who 
are  not  large  feeders,  may  tend  to  an  increased 
formation  of  the  organic  acids,  and  so  to  a  re- 
duction in  the  alkalinity  of  the  blood,  and  thus  bring 
about  uriccemia — i.e.,  a  retention  of  uric  acid  in 
the  blood. 

Thus  we  already  see  that  one  of  the  most  im- 
portant dietetic  indications  in  the  treatuient  of  the 
gouty  is  to  maintain  the  normal  alkalinity  of  the 
fluids,  and  to  maintain  or  augment  their  solvent 
power.  And  precisely  the  same  indications  with 
regard  to  food  apply  to  the  tendency  to  the  forma- 
tion of  uric  acid  gra\el  and  calculi. 

As  we  liave  already  jjointed  out,  it  is  a  well- 
established  fact  that  a  highly  nitrogenised  animal 
dietary  increases  the  acidity  of  the  fluids  of  the  body, 


426  Food  in  Disease.  (Partii. 

and  especially  of  the  urine  ;  and  it  is  equally  well 
known  that  a  vegetable  dietary  increases  their 
alkalinity. 

One  of  our  chief  objects,  therefore,  in  construct- 
ing a  dietary  for  the  gouty  is  to  diminish,  within 
suitable  limits,  the  amount  of  animal  food  they  con- 
sume, and  to  replace  it  with  an  equivalent  quantity 
of  appropriate  vegetable  substances. 

The  extent  to  which  this  can  be  carried  with 
safety  will  depend  upon  the  habits  of  life,  the  occu- 
pation, and  the  digestive  peculiarities  as  they  are  met 
with  in  individual  cases. 

For  the  indolent  and  sedentary,  animal  food 
should  be  reduced  to  a  minimum  ;  to  the  energetic 
and  active,  a  more  liberal  proportion  may  be  allowed. 
But  in  all  cases  we  must,  above  all  things,  avoid 
exciting  dyspeptic  states  by  an  unwise  urgency  of 
dietetic  rules  ill-adapted  to  the  digestive  peculiarities 
which  many  of  these  patients  present. 

Great  moderation  in  the  consumption  of  animal 
food  is,  then,  one  of  the  first  rules  for  most,  though 
not  all,*  gouty  persons. 

It  is  also  the  experience  of  the  majority  of  authori- 
ties that  in  the  food  of  the  gouty,  fats  as  well  as 
albuminates  should  be  reduced  to  the  minimum ; 
fatty,  saccharine,  and  gelatinous  foods,  by  interfering 
with  the  complete  metabolism  of  the  albuminates, 
tend  to  the  production  of  uricsemia.  Bauer  points 
out  that  we  ought  not  only  to  restrict  the  amount  of 
fat  in  the  food,  but  that  as  corpulent  persons  perspire 
freely,  and  therefore,  as  a  rule,  secrete  a  concentrated 
urine  liable  to  yield  deposits,  we  should  also  adopt 
other  means  to  prevent  the  accumulation  of  fat. 

G.  S^e  also  insists  especially  on  the  pi'ejudicial 
effects  upon  the  gouty  of  a  diet  rich  in  nitrogenous 
food  when  combined  with  sugar,  gelatin,  and  fats. 

*  It  seems  impossible  to  avoid  admitting,  for  the  evidence  is 
very  strong  in  its  favour,  that  certain  gouty  jjersons  do  better  on 
an  almost  exclusively  animal  diet  than  on  any  other.  We  sliall 
return  to  this  point  later.     (See  note  appended  to  chai)ter  vi.) 


Chap,  v.]      Dietetic  Principles  in  Gout.  427 

Ebstein,  however,  advocates  the  consuiiiption  of  a 
moderate  amount  of  fat,  so  as  to  diminish  the  quantity 
of  carbo-hydrates  needed,  as  he  regards  these  as  the 
most  fattening  of  all  foods.  He  also  considers  fat 
useful  as  quickly  satisfying  the  appetite  and  diminish- 
ing the  desire  for  food. 

We  see  no  reason  for  withholding  a  moderate 
amount  of  fatty  foods  from  gouty  persons  who  show 
signs  of  defective  nutrition,  provided  they  digest 
them  without  difficulty ;  but,  on  the  other  hand,  we 
should  restrict  them  as  much  as  possible  in  the  diet  of 
the  corpulent  and  well  nourished. 

It  is  a  grave  error  to  im[)Ose  on  the  gouty  a  too 
rigorous  abstinence.  Their  diet  must  contain  all  that 
is  needed  for  the  due  imtrition  of  the  body  and 
for  maintaining  its  functional  activity.  It  must, 
tl)erefore,  be  proportioned,  in  some  measure,  to 
the  work  and  activities  of  individual  organisms. 
But  it  is  a  wise  precaution  at  all  times  to  draw 
the  supplies  of  food,  so  far  as  is  practicable,  and 
well  within  the  digestive  capacities  of  the  patient, 
from  the  more  readily-digested  and  more  nutritious 
vegetables. 

Green  vegetables  and  fresh  fruits  are  especially 
suitable,  as  they  are  knovvn  to  render  the  urine  more 
alkaline,  while  they  do  not  favour  the  deposit  of  fat 
in  the  body ;  but  an  exclusively  vegetable  diet  is  by 
no  means  to  be  commended,  save  in  quite  exceptional 
instances. 

The  feeble  digestion  of  many  gouty  persons  is 
unequal  to  appropriating  that  comparatively  larije 
mass  of  vegetable  food  which  is  necessary  to  supply 
the  wants  of  the  system,  and  a  certain  proportion  of 
more  concentrated  and  easily -digested  animal  food  is, 
therefore,  necessary  for  them. 

White  are  generally  considered  more  appropriate 
than  brown  meats ;  and,  bulk  for  bulk,  this  may  be 
true.  But  there  is  no  proof  that  small  quantities  of 
well-cooked  and  tender  mutton  or  beef  are  more  pre- 
judicial to  the  gouty  than  larger  quantities  of  chicken 


428  Food  in  Disease.  [Partii. 

and  rabbit;  indeed,  tlie  latter,  although  a  white  meat, 
has  often  appeared  to  us  more  difficult  of  digestion 
than  beef  and  mutton. 

Tiiere  is  a  general  consent  that  smoked  and  dried 
or  pickled  pork,  game,  tish,  and  other  meats,  should 
be  proscribed,  as  they  all  present  very  condensed 
forms  of  nitrogenous  food,  and  excite  thirst,  which  is 
not  always  quenched  with  pure  water  !  Rich  and 
fat  sauces  should  be  altogether  avoided,  and  all 
entrees  and  made  dishes  which  are  served  with  sauce. 
Strong  meat-soups  and  extracts  are  also  particularly 
undesirable ;  and  when  soups  are  taken,  they  should 
be  vegetable  soups,  only  slightly  flavoured  with 
animal  extract.  One  teaspoonful  of  Valentin's  Meat- 
juice  added  to  half-a-pint  of  a  purely  vegetable  soup 
imparts  quite  as  much  of  this  flavour  as  need  be 
desired. 

Cheese,  sis  one  of  the  most  concentrated  forms  of 
nitrogenous  food,  and  as  often  difficult  of  digestion, 
should  be  avoided,  except  in  very  small  quantity. 

As  the  yolk  of  ii'^^^  contains  a  large  amount  of  fat 
and  lecithin,  eggs  should  enter  as  little  as  possible 
into  the  dietary  of  the  gouty. 

Fish,  oysters,  and  the  Crustacea  must  be  partaken 
of  sparingly,  and  the  rich  and  firmer  fish,  such  as 
salmon,  mullet,  mackerel,  and  perhaps  lobster  and 
crab,  had  better  be  altogether  avoided. 

An  almost  unlimited  choice  of  fresh  vegetable 
food  may  be  permitted  — potatoes  and  the  ordinary 
green  vegetables  and  salads.  Sorrel,  tomatoes,  and 
asparagus  have,  however,  been  especially  prohibited, 
on  the  ground  that  they  contain  oxalates,  and  oxalic 
acid  is  a  congener  of  uric  acid.  But  we  have  been 
recently  assured  that  it  is  an  error  to  proscribe  toimi- 
toes,  as  they  contain  but  a  very  small  amount  of  oxalic 
acid  ;  whereas  spinach,  which  ha.s  been  so  universally 
approved  of,  is,  next  to  sorrel,  the  richest  in  this 
acid.*  To  asparagus,  if  eaten  without  melted  butter, 
we  see  no  practical  objection.  Indeed,  we  are  inclined 
•  Dujardin-Beaumetz,  "L'Hygieae  Alimentaire,"  p.  169. 


Chap,  v.)  Food  for  the  Gouty.  429 

to  regard  the  objection  to  those  vegetables  as  rather 
theoretical  than  practical.  But  we  must  remember 
that  gouty  persons  are  very  prone  to  idiosynci-acies, 
and  we  must  therefore  be  cautious  how  we  extend 
each  individual  peculiarity  into  a  general  rule. 

Those  dry  vegetables  which  are  both  rich  in 
albuminates  as  well  as  in  carbo-hydrates,  such  as 
haricot  and  other  beans,  peas,  lentils,  should  be  par- 
taken of  only  in  small  quantity.  Mushi'ooms  and 
truffles  are  prohibited. 

Bread,  which  is  also  a  highly  nitrogenous  food, 
shoiUd  be  taken  only  in  moderation,  and  is,  perhaps, 
least  harmful  when  well  toasted.  Bouchardat  has 
proposed  to  substitute  potatoes  for  it. 

Most  fresh,  ripe  fruits  are  wholesome,  and  most 
cooked  fruits,  as  stewed  or  roasted  apples,  etc. ;  but 
the  highly-saccharine  fruits,  whether  fresh  or  dry,  are 
not  so  suitable,  and  should  be  taken  in  very  moderate 
quantities ;  and  we  must  here  again  bear  in  mind 
that  there  are  a  few  gouty  subjects  who  are  unable 
to  eat  certain  fruits  with  impunity. 

It  is  best  to  train  the  gouty  patient  to  observe 
carefully  for  himself  the  influence  of  particular 
articles  of  diet  on  his  health ;  for  although  in  the 
majority  of  cases  certain  fruits  and  vegetables  are  of 
undoubted  value,  in  the  case  of  a  small  number  of 
the  gouty  they  produce  digestive  disturbances,  and 
must  therefore  be  avoided. 

Next,  as  to  the  best  beverages  for  the  gouty  ;  and 
first,  as  to  milk.  Some  differences  of  opinion  exist 
with  regard  to  milk ;  and  no  doubt  tliere  are  great 
individual  peculiarities  in  respect  of  its  digestibility. 
Some  cannot  digest  it  at  all,  some  dislike  it  exces- 
sively, and  others  can  digest  it  in  any  quantity  and 
are  fond  of  it.  For  the  latter,  we  consider  that  it 
serves  as  an  admirable  form  of  food,  especially  if 
skimmed  or  diluted,  presenting,  as  it  does,  all  the 
principles  necessary  for  the  nutrition  of  the  body  in  a 
form  readily  assimilated  by  those  with  whom  it  agrees, 
and  containing  a  large  quantity  of  water.     It  is  an 


43°  Food  in  Disease.  (Pan  ii. 

advantage  to  render  it  slightly  alkaline,  by  adding  to 
it  some  alkaline  water,  such  as  Vals,  Vichy,  or 
Apollinaris  water,  when  it  often  acts  freely  as  a 
diuretic.  Indeed,  we  are  in  the  habit  of  advising 
our  gouty  patients,  and  those  who  have  shown  any 
tendency  to  the  deposition  of  uric-acid  gravel,  to 
drink,  about  ten  minutes  before  their  first  meal,  a 
breakfastcupful  of  hot  milk  and  water,  to  which  a 
small  level  saltspoonful  of  bicarbonate  of  potash  and 
the  same  quantity  of  table  salt  should  be  added.  In 
this  form,  well  diluted  and  rendered  distinctly  alka- 
line, we  can  see  no  objection  to  its  use ;  but,  as  we 
shall  find  presently,  Sir  H.  Thompson  is  much  opposed 
to  the  free  use  of  milk  by  those  with  a  tendency  to 
uric  acid  or  oxalate  of  lime  deposits. 

Ebstein  has  maintained,  and  Germain  See  also, 
that  of  those  who  deposit  uric  acid  gravel  there  are 
some  whose  urines  do  not  contain  any  excess  of  uric 
acid  ;  but  that  this  acid  is  deposited  simply  because 
these  urines  are  not  in  a  condition  to  hold  it  in  solu- 
tion :  either  they  do  not  contain  enough  water,  or 
they  may  contain  an  excess  of  acid  phosphates,  which 
combine  with  the  soda  needed  to  hold  the  uric  acid  in 
solution  ;  it  thus  becomes  free,  insoluble,  and  deposited 
in  the  crystalline  form.  In  such  instances  the  value 
of  an  abundance  of  slightly  alkaline  watery  beverages 
is  very  obvious.  A  large  draught  of  hot  water  half 
an  hour  before  a  meal  and  at  bedtime,  and  the  use  of 
the  alkaline  table  waters  to  mix  with  wine,  or  what- 
ever other  stimulant  is  taken,  should  be  recommended. 
The  habit  of  drinking,  in  some  form  or  other,  a  con- 
siderable quantity  of  water  is  an  important  point  in 
the  dietary  of  the  gouty ;  and  whatever  wine  or  spirit 
they  take  should  be  largely  diluted,  either  with  pure 
water  or  with  an  alkaline  eflTervescing  table-water. 
The  value  of  drinking  considerable  quantities  of 
hot  water  has  been  largely  insisted  on  by  many 
physicians,  and  we  have  had  occasion  to  form  a 
favourable  opinion  of  the  practice  if  kept  within 
certain  limits. 


Chap,  v.j       Beverages  for  the  Gouty.  431 

Strong  beers,  porter  and  stout  should  be  avoided 
by  all  gouty  persons.  We  have  known  a  few  instances 
in  which  stout  has  been  well  borne,  but  a  large  quan- 
tity of  alkaline  salts  was  at  the  same  time  taken 
habitually. 

Cider,  which  contains  malic  acid  in  combination 
with  potash,  has  been  said  by  Meissner  and  Koch  to 
favour  the  formation  of  uric  acid,  and  on  that  account 
has  been  prohibited  to  the  gouty.  Germain  See,  how- 
ever, considers  cider,  especially  when  spai'kling,  an 
excellent  diuretic,  which  favours  the  expulsion  of  uric 
acid  gravel ;  and  his  opinion  is,  as  we  shall  see,  shared 
by  Sir  H,  Thompson,  who  considers  it  a  useful  bever- 
age in  calculous  disorders. 

Of  wines,  all  strong,  sweet,  or  spirituous  wines 
should  be  carefully  avoided,  such  as  sweet  or  strong 
champagnes,  ports,  sherries,  Madeira,  Burgundy,  and 
the  stronger  clarets.  All  wines  which  contain  much 
sugar,  alcohol,  tannin,  or  free  acid  are  unsuited  to  the 
gouty.  Still  Moselle,  light  hock,  some  of  the  best 
Hungarian  wines,  light,  well-kept,  fine-quality  Bor- 
deaux— all  these  are  permissible  in  small  quantity, 
diluted  with  an  alkaline  table-water,  so  as  to  neutralise 
any  free  acid  they  may  contain.  The  more  distinctly 
diuretic  the  effect  of  the  wine,  the  better,  as  a  rule, 
will  it  agree  with  the  gouty. 

For  gouty  persons  with  cardiac  asthenia,  a  condition 
now  met  with  (since  the  visitation  of  influenza)  much 
more  frequently  than  used  to  be  the  case,  we  have 
found  2  or  3  glasses  daily  of  dry  port  that  has 
matured  in  the  wood  well  tolerated. 

With  regard  to  alcoholic  beverages  in  general,  it 
may  be  said,  unhesitatingly,  that  the  gouty  persons 
who  can  do  without  them  entirely  are  wise  to  do  so. 
If  they  cannot  exist  comfortably  without  some  small 
or  moderate  amount  of  an  alcoholic  beverage,  then 
they  must  exercise  gi-eat  care  in  its  selection.  There 
is  all  the  difference  in  the  world  between  the  effects 
of  a  fine,  mature,  high-quality  wine  or  spirit  and  the 
commoner  kinds  of  the  very  same  beverages.     They 


432  Food  in  Disease.  tPartii. 

should  always  be  well  diluted.  Of  spirits,  the  best 
are  fine  old  Scotch  whisky,  dry  Plymouth  gin,  and 
the  finer  kinds  of  French  cognac,  when  they  can  be 
obtained. 

Tea  and  coffee,  when  not  strong,  are  both  exceed- 
ingly useful  bevei'ages  to  the  gouty,  unless  they  are 
found  to  trouble  the  digestion,  which  they  will  do  with 
some  persons.  In  tliat  case  it  is  necessary  to  take 
them  without  sugar.  It  is  tlie  quantity  of  sugar  so 
commonly  taken  with  these  beverages  that  helps  to 
make  them  injurious. 

The  best  China  tea,  and  not  Indian  tea,  should  be 
employed  for  infusion,  as  the  latter  contains  far  too 
much  tannin. 

Germain  Sde  observes  : — "  Warm  aromatic  drinks 
like  tea  produce  a  kind  of  washing-out  (lavage)  of  the 
uriniferous  tubes,  which  are  the  receptacles  of  the 
uric  acid  ;  in  my  long  practice  I  have  been  furnished 
with  many  proofs  of  the  utility  of  these  beverages 
to  the  gouty."  Dujardin-Beaumetz  states,  on  the 
authority  of  Esbach,  that  black  tea,  infused  for  five 
minutes,  will  yield  as  much  as  2  grammes  per  1,000 
of  oxalic  acid,  and  he,  on  that  account,  proscribes 
its  use  in  gouty  disorders.  We  hesitate  to  accept 
this  statement  without  further  investigation,  and  we 
should  certainly  not  forbid  gouty  patients  generally 
to  drink  tea.  Persons  with  deposits  of  oxalates 
might  do  well  to  avoid  it,  as  they  are  usually 
dyspeptics. 

On  the  authority  just  quoted,  cocoa  is  also  said  to 
be  very  rich  in  oxalic  acid,  containing  from  3-5  to  4*5 
grammes  in  1,000.  If  this  should  prove  to  be  correct 
it  would  have  to  be  forbidden  in  cases  of  oxalate  of 
lime  deposits. 

Phosphatic  urinary  deposits  are  usually  secondary 
to  some  other  morbid  state,  to  the  removal  of  which 
the  dietetic  or  other  treatment  must  be  directed. 

The  formation  of  biliary  calculi  is  also  often 
found  to  occur  in  the  gouty,  and  may  doubtless  depend 


Chap,  v.]         Diet  in  Calculous  Disorders.     433 

on  the  same  causes  as  iiratic  deposits,  viz.  on  too 
great  concentration  and  defective  alkalinity  of  the 
fluids.  The  deposition  of  biliary  concretions  may 
depend  either  on  an  excess  of  cholesterin  (the  chief 
constituent  of  gall-stones)  in  the  bile,  or  on  a  de- 
ficiency in  solvent  power  of  tl)e  fluid  of  the  bile 
allowing  tlie  cholesterin  to  be  deposited,  although  it 
may  not  be  in  excess. 

The  formation  of  an  excess  of  cholesterin  appears 
to  be  sometimes  dependent  on  an  excessive  consumi)- 
tion  of  fats,  or  upon  exaggerated  activity  of  the 
nervous  functions,  cholesterin  being  looked  upon  by 
some  as  derived  from  the  products  of  nervous  waste. 

Its  deposition,  when  the  bile  is  defective  in  alka- 
linity, has  Vjeen  demonstrated  by  Thenard,  and  this 
condition  of  the  bile  has  been  traced  to  a  too  exclu- 
sive animal  dietary.  Sedentary  habits,  of  course, 
promote  such  deposits  by  favouring  the  stagnation  of 
bile  in  the  gall-bladder. 

Whatever  may  be  the  cause,  when  biliary  concre- 
tions are  known  to  exist,  a  most  carefully  regulated 
dietary  should  be  insisted  upon. 

Fatty  substances  should  be  entirely,  or  almost 
entirely,  excluded  from  the  food,  as  well  as  sugar. 

The  quantity  of  food  taken  should  be  strictly 
•within  the  limits  of  what  is  necessary  for  the  due 
maintenance  of  the  nutrition  of  the  body,  and  all 
excess  must  be  strictly  forbidden. 

Farinaceous  substances  may  be  taken  in  modera- 
tion. Peas  are  regarded  by  some  as  unsuitable,  as 
they  are  said  to  contain  a  fatty  body  analogous  to 
cholesterin. 

So  far  from  carrots  being  appropriate  in  these 
cases,  as  used  to  be  thought,  they  are  to  be  avoided, 
as  they  contain  sugar  and  "  vegetable  cholesterin." 

Animal  food  should  be  taken  in  strict  moderation, 
the  fat  being  always  avoided.  Eggs  also  sparingly, 
not  more  than  one  daily.  Green  vegetables  and 
fruits  (not  the  sweeter  kinds)  are  very  useful,  and 
so  aie  potatoes ;  bread  should  be  taken  in  moderation, 
o  c 


434  Food  in  Disease  Panii. 

For  beverage  a  little  wine  may  be  permitted,  with 
some  alkaline  water,  such  as  Apollinaris,  Vals,  or 
Vichy.  A  breakfastcupful  of  hot  water,  slowly 
drunk  or  sipped,  half  an  hour  before  meals,  is  also 
most  useful. 

Sir  Henry  Thompson,  whose  large  experience  in 
the  treatment  of  calculous  disorders  gives  to  his  testi- 
mony exceptional  value,  has  stated  it  to  be  his  belief 
that  "  in  nineteen  cases  out  of  twenty  an  undue 
deposit  of  uric  acid  will  disappear  under  a  proper 
dietary,"  and  its  formation  in  calculous  masses  be 
prevented ;  and  the  same  observation  he  applies  to 
deposits  of  oxalate  of  lime.  He  does  not,  however, 
consider  that  much  is  gained  in  such  cases  by  any 
great  diminution  of  nitrogenous  food  ;  but  he  insists 
very  strongly  on  the  necessity  of  eliminating  as  com- 
pletely as  possible  fatty  and  saccharine  substances 
from  the  dietai-y.  A  certain  limited  quantity  of 
fatty  matters  he  allows,  but  forbids  saccharine  sub- 
stances entirely.  It  is  also  best,  he  considers,  that 
all  alcoholic  drinks  should  be  avoided,  or,  in  certain 
cases,  taken  only  in  very  small  quantities.  If  a  little 
wine  is  thought  necessary,  he  prefers,  as  we  do,  in 
such  cases  that  still  Moselle  or  a  light  Rhine  wine 
should  be  drunk,  to  which  we  always  recommend 
the  addition  of  a  little  alkaline  table-water,  to 
neutralise  the  free  acid  all  these  wiues  contain.  He 
approves  also  of  a  little  very  light  beer  or  sound 
cider,  neither  sweet  nor  acid,  and  he  rightly  urges 
the  importance  of  brewing  in  England  some  light 
infusion  of  malt  and  hops  like  the  light  lager  beers 
of  Germany. 

Champagne,  if  sweet,  he  regards  as  especially 
harmful ;  but  we  have  found  a  small  quantity  of  dry 
and  sound  champagne,  mixed  with  Apollinaris  water, 
as  well  borne  as  any  other  wine  in  these  cases. 

Bordeaux  wines,  unless  unmistakably  pure  and 
sound,  as  well  as  of  light  quality,  are  to  be  forbidden, 
as  are  all  sweet  wines,  ports,  sherries,  etc.,  and  all 
strong  beers. 


Chap,  v.]  S/jR    H.    JhOMPSON'S   DiETARY.  435 

The  important  point  is,  that  all  the  beverages 
should  be  free  from  saccharine  matters. 

As  to  the  kind  of  food  prescribed  :  it  is,  in  the 
first  place,  necessary  to  ascertain  the  patient's  habits 
of  life,  whether  they  are  active  or  sedentary.  Those 
who  lead  active  lives  must  be  allowed  more  hydro- 
carbons and  more  meat  than  the  sedentary.  In 
advanced  age  it  is  of  great  importance  so  to  limit 
the  dietary  as  to  avoid  overtaxing  the  eliminative 
organs. 

The  calculous  patient  is,  in  the  greater  number  of 
cases,  too  stout,  and  he  should  be  allowed  only  a  very 
spare  amount  of  fats.  A  reduction  of  weight  is  a 
good  sign,  and  it  is  an  undoubted  advantage  if,  by 
dieting,  a  loss  of  four  or  five  pounds  in  weight  in  the 
first  month  can  be  efiected. 

When  not  corpulent,  a  less  rigid  abstinence  from 
fats  may  be  permissible. 

The  following  fat-containing  foods  must  be  es- 
chewed, or  taken  only  in  very  small  quantities : — 
Milk,  cream,  butter,  cheese,  eggs  (especially  ome- 
lettes), pastry,  fat  pork,  suet  in  puddings  and  pastes, 
and  the  fat  of  roast  and  boiled  meats.  Rice  or  sago 
puddings,  being  mixtures  of  milk,  egg,  and  sugar. 
Sir  Henry  Thompson  speaks  of  as  "  in  the  last  degree 
objectionable  for  uric-acid-making,  gouty  patients,' 
although  he  admits  that  they  are  excellent  for 
children  and  healthy  people.  Farinaceous  puddings 
may  be  permitted,  if  not  made  sweety  but  with  light 
broth  instead  of  milk,  a  moderate  amount  of  white  of 
egg,  and  some  condiment  (a  pinch  of  curry)  instead 
of  sugar. 

All  articles  of  food  containing  cane-sugar  should 
be  expunged  from  the  dietary  ;  by  so  doing  we  lighten 
the  work  of  the  liver,  and  lessen  the  manifold 
vicarious  duties  performed  by  the  kidneys. 

He   commends   the   Carlsbad   dietary,    in    which 

sugar     and     butter     are     absolutely     forbidden,     a 

method  of  reducing  uric  acid  deposits  more  effectual 

than   that   of   eliminating    meat    from    the   dietary. 

cc  2 


436  Food  in  Disease.  [PartiL 

Nitiogenous  food  in   moderation   is   permitted,    but 
the  hydrocarbons  are  greatly  diminished. 

The  following  is  the  dietary  which  Sir  H.  Thompson 
ecommends  in  calculous  affections  : — 


Fish  in  all  its  forms,  except  those  cont'iining  much  fatty 
matter — i.e.  herrings,  mackerel,  eels,  and  the  thin  part  of 
salmon. 

Game  in  all  forms.     Poultry. 

Lean  meat  in  moderate  quantity. 

Preparations  of  ytlatin. — Savoury  jelly,  or  jelly  agreeably  fla- 
voured, but  unsweetened. 

Butter  in  moderation  (this  is  the  only  direct  form  of  fat  ad- 
mitted— fat  in  some  form  being  necessary). 

An  egg  or  two,  on  account  of  their  usefulness  in  all  cooking 
operations.  (The  objection  to  eggs  applies  only  to  the 
yolk,  or  fatty  part.) 

Milk  in  strict  moderation,  and  onlj'  with  tea,  coffee,  or  cocoa. 
It  is  very  undesirable  and  noxious  in  large  quantity,  as  it 
contains  a  large  proportion  of  fat  and  sugar,  and  its  casein 
is  digested  with  ditliculty.  It  is  less  objectionable  when 
thoroughly  skimmed. 

Well-made  whole  meal  bread. 

Oatmeal.     Pearl  barley. 

Macaroni,  and  other  Italian  pastes. 

iSome  coarse  meal  is  needed  to  act  as  an  aperient  and  prevent 
constipation. 

Whole  meal  bread  is  improved  in  flavour  and  texture  by  an 
admixture  of  fine  (not  coarse)  Scotch  oatmeal,  in  the 
proportion  of  about  one-quarter  to  one-third  of  the  wheat- 
meal  employed. 

Dry  haricots  and  lentils  are  most  nutritious  vegetables,  and 
should  be  taken  made  into  purees.  They  are  digested  with 
ease,  and  contain  much  nutritious  matter. 

Jtice,  sago,  tapioca,  and  arrowroot,  are  all  useful  if  treated  as 
savoury  dishes,  not  as  sweets. 

Fresh  green  vegetables  are  especially  good. 

Fresh  green  peas  and  broad  beans,  uell  masticated. 

Light  salads  are  permissible  to  persons  who  digest  them  easily, 
but  they  must  not  be  taken  by  those  who  digest  them  with 
difficulty. 

Celery,  sea-kale,  asparagus,  tomatoes,  potatoes,  and  artichokes, 
aie  all  permitted  ;  so  also  are  apples,  roasted  or  baked, 
without  added  sugar. 

The  following  are  to  be  avoided : — Rhubarb,  gooseberries, 
currants,  strawberries,  raspberries,  grapes,  plums,  pears, 
«nd  all  sweet  fruit,  fresh  or  preserved. 

Saccharin  may  bo  substituted  for  sugar. 


Chm>.V.]  CANTANfS   DlBTARY.  437 

The  following  diet,  adopted  with  advantage  by  a 
medical  man  who  suffered  from  gout  and  gravel,  was 
published  in  the  Practitioner  : — 

7.30  a.m. — Ten  oz.  of  very  hot  water. 

8  a.in. — Breakfast.     Equal  parts  of  weak  tea  and  milk,  a  small 

quantity  of  white  sugar,  a  slice  of  fat  bacon  without  a 

strip  of  lean,  bread,  and  fresh  butter. 

I  p.m. — Milk  pudding,  rice,  sago,  tapioca,  macaroni,  a  blanc- 

mange, and  small  biscuits,  with  butter. 
Ten  oz.  of  hot  water. 
4  to  5  p.m. — Ten  oz.  of  hot  water. 

6  p.m. —  Dinner.    White  fish  or  fowl  (usually  boiled),  greens, 
bread  {no  potatoes). 
Claret,  7  oz. 
8  to  9  p.m.  — Ten  oz.  of  hot  water. 

II  p.m. — Ten  oz.  of  hot  water. 

In  this  diet  there  is  a  very  strict  limitation  of 
nitrogenous  food,  while  the  elimination  of  the  pro- 
ducts of  nitrogenous  waste  is  facilitated  by  the  inges- 
tion of  considerable  quantities  of  hot  water. 

If  this  gentleman  "  indulges  either  in  meat  or 
game,  or  drinks  copiously  of  claret,  or  omits  one  or 
two  glasses  of  hot  water,  he  feels  gouty  and  gravelly 
the  next  day." 

Cantani's  views  as  to  the  dietetic  treatment  of 
gout  are  somewhat  different  from  those  of  his  con- 
temporaries, but  they  certainly  contain  an  element 
of  truth. 

He  considers  it  best,  instead  of  severely  restricting 
the  consumption  of  animal  albuminates,  which  are  so 
necessary  to  the  nutrition  of  the  body  and  so  com- 
paratively easy  of  digestion,  ratlier  to  aim  at  securing 
their  complete  combustion  within  the  system  by 
withdrawing  from  the  dietary  whatever  substances 
are  known  to  interfere  with  their  oxidation  or  check 
their  metabolism.  He  recommends  a  moderate 
amount  of  nitrogenous  food — fish,  eggs,  broth ;  and 
the  free  use  of  green  vegetables. 

He  forbids  all  starchy  and  saccharine  foods — 
bread,  rice,   potatoes,  sweets,  and   sweet   fruits  ;   he 


438  Food  in  Disease.  [Pan  11. 

prohibits  all  alcoholic  drinks,  all  pungent  condiments, 
and  coffee  ;  all  acids  and  acid  foods,  milk,  and  es- 
pecially cheese,  as  he  considers  the  injurious  effects 
of  lactic  acid  and  the  fatty  acids  in  cheese  can  be 
directly  established. 

He  advises  the  consumption  of  large  quantities  of 
fluid,  and  especially  of  pure  aerated  waters. 


439 


CHAPTER  VI. 

THE    TjIETBTIC   TREATMENT   OP    OBESITY. 

Various  dietetic  methods  have  been  advocated  for 
the  cure  of  obesity,  but  they  have,  most  of  them, 
had  the  same  end  in  view,  viz.  the  reduction  of  the 
total  amount  of  food  taken.  In  a  very  large  propor- 
tion of  the  cases  of  excessive  corpulence  a  reduction 
in  the  quantify  of  food  taken  is  the  essential  con- 
dition of  its  cure ;  and  that  reduction  must  be 
sufficient  to  remove  all  excess  of  fat-forming  food  (and 
there  is  scarcely  any  form  of  food,  as  we  have  seen 
in  previous  chapters,  from  which  fat  cannot  be 
formed)  from  the  dietary. 

Let  us  take  a  hypothetical  case.  A  person  with  a 
tendency  to  obesity,  who  appears  to  be  a  very  moderate 
feeder,  happens  to  take,  in  excess  of  his  wants,  half 
an  ounce  of  sugar  daily,  which  we  will  assume  is 
converted  into  and  is  stored  up  in  his  body  as  fat. 
This  is  adequate  to  a  yearly  increase  in  weight  of  over 
eleven  pounds,  or  in  five  years  to  four  stones  !  Let 
us,  then,  bear  this  fact  in  mind  in  dealing  with  cases 
of  obesity,  that  a  patient  weighing  twelve  stones  may 
add  four  stones  to  his  weight  in  five  yeai*s,  simply 
by  the  daily  deposition  within  his  lx>dy  of  half  an 
ounce  of  fat  derived  from  this  small  daily  excess  of 
fat-producing  food. 

The  most  common  cause  of  obesity  is  an  excess 
of  food,  although  in  some  cases  it  may  be  difficult  at 
first  to  discover  in  what  particular  there  is  excess  ; 
for  we  must  also  recognise  a  peculiar  constitutional, 
and  often  inherited,*  aptitude  for  fattening — observed 

*  "Statistics  permit  the  assumption  that  among  the  corpulent 
patients  coming  under  observation  at  least  fifty  per  cent,  have 
an  hereditary  tendency  to  disturV>ances  of  nutrition." — Oertel, 
"Nineteenth  Century  Practice,"  1895. 


440  Food  in  Disease.  tPanii. 

also  in  many  animals — wliich  leads  to  the  development 
of  obesity  from  an  almost  inappreciable  excess  of 
food  or  drink. 

There  is,  also,  another  important  preliminary 
consideration  to  be  kept  in  view,  and  that  is,  that 
different  obese  persons  may,  and  probably  do,  possess 
different  faculties  for  the  conversion  of  different 
kinds  of  food  into  fat,  so  that  one  person  may  derive 
his  excess  of  fat  from  one  class  of  food,  and  another 
from  another  class ;  and,  therefore,  that  the  remedial 
measures  appropriate  and  successful  in  some  cases  may 
not  be  those  best  calculated  to  lead  to  a  successful 
result  in  others.  Each  case  of  obesity,  therefore, 
must  be  made  the  subject  of  individual  study  and 
analysis,  although  certain  general  principles  are 
doubtless  applicable  to  the  great  majority. 

The  frequent  occurrence  of  obesity  about  and 
after  middle  age  points  also  to  another  very  important 
consideration,  viz.  that  the  need  of  food  naturally  di- 
minishes with  advancing  years,  just  as  the  capacities 
for  digesting  and  assimilating  and  duly  utilising  food 
diminish  also.  Ignorance  or  insufficient  recognition 
of  this  fact  is  the  chief  reason  why  it  is  so  difficult  to 
deal  successfully  with  many  of  these  cases.  It  is 
difficult  to  make  a  man  of  forty  understand  that  he 
cannot  properly  utilise  and  adequately  dispose  of  as 
much  food  as  he  used  to  when  thirty,  or  a  man  of 
fifty  as  much  as  when  he  was  forty  ;  so  that  a  diet 
which  would  not  be,  in  any  way,  excessive  at  the 
former  age,  becomes  distinctly  excessive  and  pro- 
vocative of  undesirable  corpulence  at  the  latter. 
Even  some  physicians  have  overlooked  this  important 
point  in  estimating  the  avera'je  diet  needed  l\v  corpu- 
lent persons  at  and  beyond  middle  age.  It  is  an 
error  to  apply  the  ordinary  nverar/e  ration,  especially 
to  persons  of  sedentary  habits  and  occupations,  at, 
approaching,  or  beyond  middle  age.  With  advancing 
age  there  should  be  a  diminution  in  the  average  amount 
of  food  taken. 

It  cannot  be  too  clearly  understood  that  it  is  to 


Chap. VI.]  Causes  of  Obesity.  441 

tlie  neglect  of  this  consideration  that  so  many  in- 
stances of  undue  corpulency  are  attributable  in 
advancing  life.  The  capacity  for  muscular  exertion 
is  also  lessened,  and  there  is  no  longer  either  the 
disposition  or  the  ability  to  engage  in  those  active 
physical  exercises  which  in  earlier  years  dispose  of 
much  of  the  surplus  food  supply,  as  has  been  already 
explained. 

There  is,  however,  a  certain  small  or  moderate 
proportion  of  cases  of  obesity  that  appear  to  arise 
independently  of  any  excess  of  food,  and  to  be  deter- 
mined by  some  morbid  state  of  system  leading  to 
defective  oxidation  and  imperfect  combustion  of 
certain  elements  of  the  food  within  the  body.  To 
this  class  must  be  referred  some  of  the  "fat  ansemics  " 
alluded  to  by  Dr.  Weir  Mitchell ;  the  cases  of  obesity 
associated  occasionally  with  the  hysterical  state,  and 
other  nervous  disorders ;  as  well  as  the  gravest  cases 
of  all,  viz.  those  cases  in  which  fatty  degeneration 
of  the  nitrogenous  tissues  accompanies  the  excessive 
deposition  of  fat. 

These  cases  must,  of  course,  be  carefully  differen- 
tiated from  the  ordinary  common  form  of  obesity,  and 
their  treatment  must  be  determined  by  other  considera- 
tions. The  chief  of  these  are  to  endeavour  to  raise 
the  tone  of  the  organs  of  circulation — to  improve  the 
quality  of  the  blood  by  enriching  it  with  oxygen 
carrying  blood  corpuscles,  and  so  to  promote  healthy 
oxidation  and  metabolism.  In  carrying  out  these 
objects  we  shall  be  assisted  by  the  administration 
of  suitable  tonics,  by  an  out-of-door  life,  by  exercise, 
active  or  passive,  according  to  the  strength  and 
capacity  of  the  patient,  by  a  dietary  largely  composed 
of  nitrogenous  and  readily  digestible  foods,  and  by 
regular  aperients  and  by  the  judicious  use  of  baths 
and  frictions. 

Dr.  Weir  Mitchell  suggests  that  climate  may 
have  much  to  do  with  the  tendency  to  obesity,  and 
he  says  the  first  thing  ain  American  in  England  is 
struck   with   is   "the    number    of    inordinately   fat 


442  Food  in  Disease.  [Partii. 

middle-aged  people,  and  especially  of  fat  women."* 
But  it  is  very  doubtful  if  England  has  a  greater 
proportion  of  very  fat  people  than  other  European 
countries,  and  an  American  visitor  to  Carlsbad  or 
Marienbad  would  probably  discover  that  the  fattest 
people  undergoing  a  cure  at  these  places  would  be  of 
other  than  English  nationality. 

Allusion  has  already  been  made  to  the  association, 
in  some  rare  cases,  of  anfemia  Avith  obesity.  This  is 
somewhat  difficult  of  explanation ;  but  we  believe  it 
will  be  found,  as  we  have  already  suggested,  that 
even  in  these  cases  some  fault  of  diet  often  lies  at  the 
root  of  the  conditnon.f  Weir  Mitchell  points  out  that 
the  hysterical  constitution,  when  associated  with  in- 
disposition to  exertion  and  prolonged  rest,  together 
with  the  morphia  habit,  "  makes  up  a  group  of  con- 
ditions highly  favourable  to  increase  of  fat." 

Many  systems  have  been  devised  for  the  cure  of 
obesity,  and  more  or  less  success  has  been  claimed  for 
all  of  them.  We  shall  pass  briefly  in  review  the  chief 
of  these,  and  point  out  what  we  consider  to  be  their 
respective  merits  and  defects. 

One  of  the  first  to  call  attention  to  the  importance, 
in  these  ca.ses,  of  diminishing  the  amount  of  water 
taken,  or  of  foods  containing  water,  was  Dancel,  a 
French  military  doctor,  who  had  been  struck  by  the 
remarkable  influence  that  water  and  watery  foods 
had  in  causing  great  abdominal  development  in 
horses.  His  method  of  reducing  obesity  was  to  pre- 
scribe as  dry  a  diet  as  possible.  The  food  taken 
should  contain  very  little  water,  and  very  little  drink 
should  be  taken  at  any  time.  Soups  and  fluid  foods 
were  forbidden.  Not  more  than  from  six  to  twelve 
ounces  of  fluid  was  allowed  at  each  meal.     Abstinence 

*  "Fat  and  Blood."    Fifth  edition,  p.  21. 

t  Oertel  says,  ' '  One  of  the  chief  catises  which  produce  tliese 
conditions  lies  in  the  hypoplastic  anaemia,  in  the  slight  haemoglo- 
bin contents  of  the  blood,  in  the  decreased  absorption  of  oxygen, 
and  in  the  lessening  of  the  oxidation  processes  in  the  body." — 
"Nineteenth  Century  Practice,"  vol.  i.  p.  638. 


Chap.  VI.)  The  Banting  Method.  443 

from  fatty  and  farinaceous  foods  was  also  enforced, 
frequent  purges  were  enjoined,  and  much  exercise 
on  foot. 

This  system,  rigorously  carried  out,  was  in  many 
instances  attended  with  remarkably  good  results. 

The  Banting  method,  so  widely  adopted  in 
England  at  one  time,  agreed  to  some  extent  with  the 
preceding,  in  the  strict  limitation  of  the  amount  of 
fluid  taken,  and  the  exclusion  of  farinaceous  foods,  as 
well  as  sugar  and  fats.  But  in  the  Banting  diet  the 
quantity  of  food  of  every  kind  was  strictly  limited. 

Breakfast  at  9  a.m.  consisted  of  5  to  6  oz.  of  animal  food — meat 

or  boiled  fish  (except  pork  or  veal)  ;  a  little  biscuit,  or  1  oz. 

of  dry  toast ;  6  to  7  oz.  of  solids  in  all.     A  lai'ije  cup  of 

tea  or  coffee  (without  milk  or  su^r)  =  9  oz.  of  liquid. 
Dinner  at  2  p.m. — Fish  or  meat  (avoiding  salmon,  eels,  hemngs, 

pork,  and  veal),  5  to  6  oz.,  any  kind  of  poultry  or  game. 

Any  vegetables,  except  potato,  parsnips,  beetroot,  turnips, 

or  carrot.     Dry  toast,  1  oz.     Cooked  fruit,  unsweetened. 

Good  claret,  sherry,  or  Madeira,  10  oz.     Total  of  solids, 

10  to  12  oz. 
Tea,  6  p.m. — Cooked  fruit,  2  to  3  oz.,  a  rusk  or  two  ;  2  to  4  oz. 

of  solids.     9  oz.  of  tea,  without  milk  or  sugar. 
Supper,  9  p.m. — ISIefit  or  fish,  as  at  dinner,  3  to  4  oz.     Claret, 

or  sherry  and  water,  7  oz. 

This  diet  allowed  only  from  21  to  27  oz.  of  solids 
per  diem,  of  which  13  to  16  oz.  consisted  of  animal 
food,  and  only  2  oz.  of  bread  ;  the  rest  consisted  of 
fruit  and  fresh  vegetables.  There  was  the  strictest 
possible  exclusion  of  starches  and  sugar. 

The  total  fluid  was  limited  to  35  oz.  — i.e.  about  a 
pint  and  three-quarters. 

With  this  diet  Mr.  Banting  reduced  himself  in  a 
year  from  14  st.  6  lb.  to  1 1  st.  2  lb. 

The  Ebstein  method,  which  has  been  largely  applied 
in  Germany,  difiers  from  the  preceding  in  recognising 
the  possible  transformation  of  albuminates  into  fat ; 
and  Ebstein  considers  that  this  transformation  is 
chiefly  dependent  on  the  simultaneous  free  u.se  of  carbo- 
hydrates, but  that  the  consumption  of  fat  has  little 
or  no  influence  in  this  direction.      He  recommends 


444  Food  in  Disease.  [Pan  ii. 

the  use  of  fat  because  it  produces  a  feeling  of 
satiety  or  satisfaction,  and  so  leads  to  the  consump- 
tion of  less  food ;  and  also,  by  diminishing  thirst, 
lessens  the  desire  for  fluids.  Dujardin-Beaumetz 
points  out  that  Hippocrates  anticipated  Ebstein  iti 
this  matter,  and  he  quotes  his  advice  to  the  obese 
that  they  should  eat  fat  on  account  of  its  satisfying 
effects  and  its  influence  in  lessening  the  consumption 
of  food.  Ebstein  maintains  that  it  is  precisely  owing 
to  the  presence  of  fat  in  food  that  the  accumulation 
of  fat  in  the  body  is  prevented,  and  he  consequently 
advises  all  kinds  of  fatty  food — the  fat  of  meat, 
butter,  cream,  and  fatty  sauces  and  soups  ;  but  he 
rigorously  forbids  the  carbohydrates,  such  as  sugar, 
potatoes,  and  all  forms  of  starchy  food,  and  he  only 
allows  31  oz.  of  bread  per  diem.  He  permits  aspa- 
ragus, spinach,  cabbage,  peas  and  beans,  and  all  kinds 
of  meat  in  small  quantity.  The  following  is  ^n 
example  of  the  Ebstein  regime  : — 

Breakfast  (6  am.  in  summer,  7.30  a.m.  in  winter). — White 
bread,  well  toasted,  rather  less  than  2  oz.,  and  well 
covered  with  butter.     Tea,  without  milk  or  sugar,  8  or  9  oz. 

Dinner,  2  p.m. — Soup  made  with  beef-marrow.  Fat  meat,  with 
fat  sauce,  4  to  5  oz.  A  moderate  quantity  of  the  veget- 
ables mentioned  above.  Two  or  three  glasses  of  light 
white  wine.  After  the  meal,  a  large  cup  of  tea,  without 
milk  or  sugar. 

Supper,  at  7.30  p.m.  — An  egg,  a  little  roast  meat,  with  fat. 
About  an  ounce  of  bread,  well  covered  with  butter.  A 
large  cup  of  tea,  without  milk  or  sugar. 

It  will  be  observed  that  this  is  a  very  spare 
dietary,  although  it  contains  a  considerable  propor- 
tion of  fat, 

The  large  cup  of  tea  three  times  a  day  is,  no 
doubt,  intended  to  enable  the  small  amount  of  food 
to  be  borne  without  a  feeling  of  exhaustion. 

Oertel,  however,  contends,  and  we  think  justly, 
that  Ebstein's  view,  "  that  fat  in  the  food  does  not 
give  ri.se  to  fat  formation,  is  one  directly  opposed  to  all 
physiological  investigations,"  and  that  the  transition 


Chap.  VI.] 


The  Oertel  Method. 


445 


of  food  fat  into  body  fat  has  been  settled  beyond 
a  doubt.* 

One  of  the  most  popular  systems  for  reducing 
obesity  is  that  advocated  by  Oertel,  and  adopted, 
with  some  modilication,  by  Schweninger.  It  will  be 
desirable,  therefoi-e,  to  describe  it  in  detail. 

Oertel  claims  for  his  system  that  it  not  only 
provides  for  the  removal  of  fat,  but  also  prevents  its 
re-accumulation ;  it  also  maintains  the  amount  of 
albumin,  and,  at  the  same  time,  restores  tone  to 
the  organs  of  circulation,  which  so  often,  in  cases  of 
excessive  obesity,  is  lost.  He  distinguishes  two  de- 
grees of  obesity — one,  the  slighter  form,  in  which  the 
organs  of  circulation  are  unaffected,  and  vigorous 
bodily  exercise  is  possible  ;  and  another — the  graver 
form — in  which  the  muscle  of  the  heart  is  invaded 
and  weakened,  and  other  functional  derangements 
connected  therewith  are  developed. 

Adopting  Voit's  statement  that  the  human  body 
decreases  in  fat  if  the  daily  food  consists  of  the  three 
great  groups  of  food  in  the  following  proportions : — 
Albuminous  food,  about  4i  oz.  ;  fatty  food,  about 
\\  07..  ;  and  carbohydrates,  about  5|  oz. — the  follow- 
ing comparative  table  shows  the  relations  of  the 
Banting,  Ebstein,  and  Oertel  methods  to  the  above 
theoretical  estimate  and  to  one  another  : — 


Banting 
Ebstein 
Oertel  . 


Albuniinales. 


6  oz. 

3i  oz. 

5^  to  G  oz. 


Fats. 


i^OZ, 

3  oz. 
1  to  1^  oz. 


Cail)ohjdrate.« 


•li  oz. 

If  oz. 
•1\  to  3J  oz. 


They  all  agree  in  reducing  largely  the  carbo- 
hydrates, so  that  there  is  a  general  consent  that 
these  foods  greatly  contribute  to  the  excessive  de- 
posit of  fat. 

Oertel's  formula  differs  from  the  Banting  formula 

*  Oertel  on  Obesity.      "Nineteenth  Century  Practice,"  voL 
ii.  p.  642. 


446  Food  in  Disease.  [Panii. 

simply  in  allowing  considerably  more  fat  and  slightly 
more  starchy  food.  It  differs  greatly  from  Ebstein's 
in  allowing  nearly  twice  as  much  albuminous  food, 
less  than  half  as  much  fat,  and  about  twice  as  much 
carbohydrates.  This  amount  of  fat  and  carbohydrates 
is  admissible  in  those  cases  where  active  exercise  can 
be  and  is  taken,  as  muscular  exertion  is  attended 
with  a  considerable  destruction  of  fat,  and  the  relative 
excess  of  albuminous  food  in  this  formula  leads  to  the 
displacement  of  the  fat  accumulated  in  the  substance 
of  the  muscles,  and  to  a  new  formation  of  muscular 
tissue  in  its  place.  At  the  same  time  this  diet 
protects  the  nitrogenous  tissues  from  waste — a  neces- 
sary condition  of  health  which  is  lost  sight  of  in 
Ebstein's  method.  Indeed,  the  central  idea  in  this 
"cure"  is  to  strengthen  tlie  muscle  of  the  heart,  and 
this  is  aimed  at,  not  only  by  a  carefully-considered 
dietary,  but  by  the  prescription  of  regular,  active 
bodily  exercise  and  suitable  gymnastics. 

This  method  is  somewhat  modified  in  the  manage- 
ment of  those  graver  cases  where  the  accumulation  of 
fat  about  the  heart  has  led  to  great  embarrassment  of 
that  organ,  and  to  consequent  visceral  congestion  and 
even  to  dropsy.  In  such  cases  the  fat  and  carbo- 
hydrates of  the  food  are  still  further  reduced,  and  the 
amount  of  fluid  consumed  is  severely  restricted,  and 
perspiration  is  promoted  by,  if  possible,  long-continued 
bodily  exercise,  especially  in  climbing  graduated  as- 
cents ;  if  this  is  not  possible,  the  fluids  are  reduced 
by  inducing  perspiration  by  means  of  vapour  and 
other  baths. 

The  beneficial  effect  of  this  treatment  is  soon  felt ; 
the  dropsy  and  congestions  decrease,  the  pulsations  of 
the  heart  become  stronger  and  more  regular,  and  the 
patient  feels  himself  getting  stronger  day  by  day — at 
least,  such  is  the  author's  account  of  the  results  of 
this  method. 

The  following,  then,  are  the  objects  aimed  at  in 
this  "cure"  :  — 

1.  To  improve  the  muscular  tone  of  the  heart ; 


Chap.  VI.]  The  Oertel  Method.  447 

2.  To  maintaiii  the  normal  composition  of  the 
blood ; 

3.  To  regulate  and  restrict  the  quantity  of  fluid  in 
the  body ;  and 

4.  To  prevent  the  deposit  of  fat. 

And  these  objects  are  attained  by  the  following 
means  : — 

1.  The  muscle  of  the  heart  is  strengthened  by 
enforced  exercise — by  walking  or,  better,  by  climbing 
lieights.  The  patient  should  walk  slowly  uphill  until 
palpitation  comes  on,  when  he  must  stop  until  he 
can  again  breathe  easily,  but  he  must  not  sit  down. 
He  must  walk  several  hours  a  day,  and  climb  as 
much  as  possible.  He  should  go  upstairs  now  and 
then  by  way  of  exercise.  Of  course  the  capacity  for 
taking  exercise  will  be  found  to  differ  in  different  cases. 
Too  much  must  not  be  required,  but  also  not  too  little. 

Oertel  has  "  established  sanatoria  in  various  hilly 
and  mountainous  regions  of  Germany,  Austria,  and 
Switzerland,  where  methodical  and  strictly  supervised 
exercises  in  the  shape  of  walks  or  mountain-climbing 
can  be  performed  so  as  to  permit  the  necessary 
mechanical  labour  and  ensure  the  combustion  of  fat 
which  is  its  object." 

2.  To  preserve  the  normal  composition  of  the 
blood,  the  food  should  be  chiefly  albuminous.  It 
may  consist  of  the  lean  of  roast  or  boiled  beef,  veal, 
mutton,  game,  and  eggs.  Green  vegetables,  such  as 
cabbage  and  spinach,  may  be  taken  ;  fat  and  carbo- 
hydrates only  in  very  limited  quantities;  from  4  to 
6  oz.  of  bread  per  diem. 

3.  To  regulate  the  quantity  of  fluid  in  the  body, 
the  amount  of  fluid  drunk  daily  must  be  limited. 
One  cup  (rather  less  than  6  oz.)  of  coffee,  tea,  or  milk, 
morning  and  evening,  and  about  12  oz.  of  wine,  with 
from  8  to  16  oz.  of  water,  should  comprise  all  the 
fluid  consumed  in  twenty-four  hours.  In  the  hot 
season  the  amount  of  fluid  may  be  slightly  increased, 
if  the  case  is  not  one  of  the  graver  kind.  Beer  is 
entirely  forbidden. 


448  Food  in  Disease.  [Partii. 

The  discharge  of  fluid  from  the  body  is  promoted 
by  such  exercise  as  has  been  described  ;  and  if  this 
is  not  possible,  a  course  of  baths  with  packing  should 
be  taken  several  times  in  the  year.  Eacli  course 
should  last  four  or  five  weeks,  and  the  baths  should 
be  taken  about  twice  a  week. 

4.  To  prevent  the  deposit  of  fat,  the  principles 
of  diet  already  set  forth  must  be  carried  into  practice 
as  follows  : — 

Morning. — One  cup  of  coffee  or  tea,  with  a  little  milk — 
altogether  about  6  oz.     Bread,  about  3  oz. 

yoon. — 3  to  4  oz.  of  5o\\\^,  7  to  8  oz.  of  roast  or  boiled  beef, 
veal,  game,  or  not  too  fat  i^oultry,  s-alad  or  a  light  veget- 
able, a  little  fish  (cooked  without  fat),  if  desired,  I  oz.  of 
bread  or  farinaceous  pudding  (never  moro  than  3  oz.),  3  to 
6  oz.  of  fruit,  fresh  preferred,  for  dessert.  It  is  desirable 
at  this  meal  to  avoid  taking  fluids,  but  in  hot  weather,  or 
in  the  absence  of  fruit,  6  to  8  oz.  of  light  wine  may 
be  taken. 

Afternoon. — The  same  amount  of  ccffeo  or  tea  as  in  the 
morning,  with  at  most  G  oz.  of  water;  an  ounce  of  bread 
as  an  exceptional  indulgence  ! 

FAcning.—OxiQ  or  two  soft-boiled  eggs,  an  ounce  of  bread, 
perhaps  a  small  slice  of  cheese.  iSalad  and  fruit ;  6  to  8  oz. 
of  w  ine  with  4  or  5  oz.  of  water. 

A  larger  quantity  of  liquid  than  that  prescribed 
should  never  be  taken  at  one  meal.  It  is  best  to 
drink  the  quantity  allowed  in  small  portions  at 
different  times  in  the  day. 

In  simple  corpulency,  without  any  disturbances  of 
the  circulatory  organs,  the  quantity  of  fluid  may  be 
gradually  increased ;  one  or  two  glasses  of  wine  may 
be  permitted  at  the  midday  meal,  and  half  a  bottle  of 
wine  and  half  a  pint  of  water  in  the  evening. 

Such  is  the  so-called  "  Schweninger  "  or  "  Oertel 
cure." 

What,  however,  especially  characterises  Schwen- 
inger's modification  of  this  method  is  the  entire  sup- 
pression of  any  beverage  at  meals.  Whatever  fluid  is 
taken  must  be  drunk  two  hours  after  food. 

Schleicher,  of  Antwerp,  has,  however,  published  a 
*-yi)ical  diet  of  Schweninger,  which  was  adopted  with 


Chap.  VI.]  Beverages  in  Obesity.  449 

great  success,  in  which  the  exclusion  of  fluid  at  meals 
was  not  insisted  on  absolutely  : — 

Breakfast,  7  a.m. — A  mutton  or  veal  cutlet,  or  a  portion  of  sole 
as  big  as  the  palm  of  the  hand— the  same  quantity  of 
bread,  without  butter. 

8  a.m. — A  cup  of  tea,  with  sugar. 

10.30  a.m.— A  sandwich  of  bread  and  moat,  or  sausage. 
Noon.— Meat,  eggs,  green  vegetables,  cheese,  an  orange.     Two 

glasses  of  white  wine.     (No  soup,  no  potatoes.) 
4  p.m. — Tea,  with  sugar. 
7  p.m. — A  small  quantity  of  bread  and  cheese. 

9  p.m. — Cold  meat,  eggs,   salad.     Two   glasses  of  wine,   and 

sometimes  more. 

Germain  S^e  protests  against  the  limitation  of 
beverages  in  some  of  the  foregoing  systems.  He 
maintains,  on  the  contrary,  that  an  abundance  of 
water  is  most  useful.  "I  have  been  able,''  he  says, 
"  to  treat  and  to  cure  a  great  number  of  cases  by  a 
regime  of  albuminates  and  fats,  together  with  a 
great  quantitij  of  drink,  especially  of  warm  ai'omatic 
drinks."*  Hot  tea  is  the  beverage  he  especially 
favours.  Water,  he  urges,  aids  digestion  by  its 
solvent  powei*,  stimulates  organic  changes  in  the 
tissues,  and  promotes  the  elimination  of  waste  ma- 
terial. The  strict  limitation  of  water,  he  points  out, 
must  be  very  injurious  in  those  gouty  constitutions 
with  a  tendency  to  uric  acid  deposits,  which  so  often 
show  a  disposition  to  corpulency.  "  The  mo.st  useful 
beverages,"  he  says,  "  are  infusions  of  tea  and  coflFee ; 
and  the  preference  should  be  given  to  tea,  taken  at 
breakfast  in  considerable  quantity  and  at  a  high 
temperature.  All  obese  persons  who  take  this  beverage 
habitually  at  or  between  their  meals  obtain  better 
results  than  from  pure  water,  even  taken  cold." 

Alcoholic  drinks  he  strictly  forbids  on  account  of 
their  well-known  tendency  to  favour  fattydegeneration. 
A  little  wine  and  water  is  the  most  he  permits. 

He  approves  of  Ebstein's  system,  with  the  modifi- 
cation here  indicated,  and  reports  excellent   results 

•  "  Du  Regime  Alimentaire.     Kt5gime  dea  Obises." 
D  D 


45 o  Food  in  Disease.  [Panii. 

from  its  application.  He  lias,  however,  observed 
some  difficulty  in  digesting  the  fats,  and  some 
dyspepsia  provoked  in  certain  instances. 

Weir  Mitchell*  advocates  "  rest,  milk  dietetics, 
and  massage  in  people  who  are  merely  cumbrously 
loaded  with  adipose  tissues,  and  also  in  the  very 
small  class  of  anremic  women  who  are  excessively 
fat."  He  maintains  that  on  skimmed  milk — i.e.  milk 
without  cream — fat  people  lose  flesh,  and  that  a  large 
amount  of  weight  may  be  got  rid  of  rapidly  and 
safely  by  the  following  means.  "  The  person  whoso 
weight  we  decide  to  lessen  is  placed  on  skimmed 
milk  alone,  with  the  usual  precautions ;  or  at  once 
we  give  skimmed  milk  with  the  usual  food,  and  in  a 
week  put  aside  all  other  diet  save  milk,  and  all  other 
fluids.  When  we  find  what  quantity  of  milk  will 
sustain  the  weight,  we  diminish  the  amount  by 
degrees  until  the  patient  is  losing  half  a  pound  of 
weight  each  day,  or  less  or  more,  as  seems  to  be  well 
borne.  Meanwhile,  during  the  first  week  or  two  rest 
in  bed  is  enjoined,  and  later,  for  a  vai-ying  period,  rest 
in  bed  or  on  a  lounge  is  insisted  upon,  while  at  the 
same  time  massage  is  used  once  or  twice  a  day,  and 
later  in  the  case  Swedish  movements.  At  the  same 
time,  the  pulse  and  weight  are  observed  with  care,  so 
that  if  there  be  too  rapid  loss,  or  any  sign  of  feeble- 
ness, the  diet  may  be  increased.  In  many  such  cases 
I  allow  daily  a  raodei'ate  amount  of  beef,  or  chicken, 
or  oyster  soup,  more  as  a  relief  to  the  unpleasantness 
of  a  milk  diet  than  for  any  other  reason.  When  the 
weight  has  been  sufficiently  lowered,  we  add  to  the 
diet,  beef,  mutton,  oysters,  etc.,  and  finally  arrange 
a  full  diet  list,  to  include  but  a  moderate  amount  of 
liydrocarbons.  Meanwhile,  the  milk  remains  as  a 
lai'ge  part  of  the  food,  and  the  active  Swedish  move- 
ments are  still  kept  up  as  a  habit,  the  patient  being 
directed  by  degrees  to  add  the  usual  forms  of  exercise. 
If  we  attempt  to  make  so  speedy  a  change  in  weight 
while  the  patient  is  afoot,  the  loss  is  apt  to  be 
*  "  Fat  and  Blood,"  pp.  104-106. 


Chap.  VI.] 


Diet  in  Obesity. 


451 


gravely  felt ;  but  with  the  precautions  here  advised 
it  is  interesting  and  pleasant  to  see  hovir  great  a 
reduction  may  be  made  in  a  reasonable  time  without 
annoyance,  and  with  no  obvious  result  except  a  gain 
in  health  and  comfort." 

The  great  difficulty  in  applying  this  method  lies 
in  the  enforced  rest  in  bed  for  a  week  or  two  which 
it  requires,  and  which  few  men  engaged  in  any  kind 
of  occupation  would  be  willing  to  adopt.  It  is  more 
ap]iHcable  to  women  without  serious  occupation. 

In  reviewing  these  various  dietetic  methods  of 
treating  obesity  it  will  be  seen,  as  we  have  already 
pointed  out,  that  they  all  aim  at  reducing  the  average 
quantity  of  food  taken.  If  we  compare  the  normal 
average  daily  ration  with  that  permitted  in  these 
methods,  this  fact  becomes  very  evident : — 


Normal      average 

(grammes)* 
Banting 
Ebstein 
Oertcl  . 


Albuminates. 


130 

170 

100 

100-179 


Fat. 


84 

10 

85 
25-40 


Carboliydrates. 


404 

80 

.50 

70-110 


The  carbohydi-ates  ai-e  especially  attacked  in  all 
these  methods,  and  very  largely  reduced.  There 
would  seem  to  be  a  far  greater  tendency  to  excess  in 
this  class  of  food  than  in  the  other  classes.  In  two 
of  these  methods  there  is  an  excess  of  albuminates  ; 
this  excess  has  been  considered  to  favour  the  reduction 
of  obesity  by  i)romoting  the  oxidation  and  combustion 
of  the  excess  of  deposited  fat.  This  view  of  the  effect 
of  an  excess  of  albuminates  has  been  carried  to  an 
extreme  in  a  method  recently  introduced  from 
America,  and  sometimes  spoken  of  as  the  "Salisbury" 
method.  It  is  usual  in  this  method  to  restrict  the  diet 
absolutely  for  a  time  to  large  quantities  of  rump-steak, 


Molesobott's. 


DD  2 


452  Food  in  Disease.  [Panii. 

cod-fish,  and  hot  water.  One  of  the  strongest  advo- 
cates (Towers-Smith)  of  this  method  gave  three  pounds 
of  rump-steak  and  one  pound  of  cod-fish,  together  with 
six  and  one-third  pints  of  hot  water,  as  the  flaily  diet 
for  the  first  fortnight.  Tlie  next  three  weeks  the 
hot  water  is  reduced  to  four  pints,  and  other  kinds 
of  lean  meat  and  fish  are  allowed,  as  well  as  a  little 
gi-een  vegetable,  and  unsweetened  rusks.  During  the 
following  month  tlie  hot  water  is  reduced  to  about  a 
quart  a  day,  and  some  crusts  of  stale  bread,  captain's 
biscuits,  grilled  meat,  or  ))0ultiy,  or  game  of  any  kind, 
and  hock  or  claret  with  seltzer  water,  are  allowed.  A 
slice  of  lemon  may  be  used  to  flavour  each  tumbler  of 
hot  water.  Five  grains  of  bicarbonate  of  potash  are 
also  prescribed  night  and  morning. 

This  diet  would  be  absolutely  impossible  of 
a]iplication  in  many  cases,  from  utter  inability  to 
consume  so  large  an  amount  of  animal  food.  Inoidi- 
nately  large  eaters  might,  however,  find  it  successful. 

But  in  the  application  of  this  method  it  is  not 
always  necessary  that  such  large  quantities  of  meat 
should  be  eaten.  Remarkable  results  have  been 
obtained  from  the  limitation  of  the  food  to  one  pound 
of  cooked  fish  and  one  pound  of  cooked  lean  meat 
daily,  together  with  the  consumption  of  a  pint  of 
warm  water  every  two  hours — the  water  to  be  taken 
as  warm  as  it  can  comfortably  be  drunk,  and  sipped 
slowly.  The  fish  and  meat  are  distributed  into  various 
meals  according  to  the  inclination  of  the  patient ;  no 
bread,  vegetables,  milk,  or  any  other  article  of  diet 
must  be  allowed.  A  patient  who  took  this  diet,  with 
five  to  six  pints  of  warm  water  daily,  was  reduced 
in  four  months  from  20  stones  4|  lbs,  to  17  stones 
1  lb.  The  diet  was  then  slightly  modified.  He  was 
allowed  two  small  slices  of  bread-and-butter  with 
breakfast  and  tea,  and  milk  and  sugar  were  added  to 
his  tea  morning  and  evening.  His  weight  still  con- 
tinued to  diminish,  and  reached  IG  stones  7  lbs.  He 
then  was  allowed  to  return  to  ordinary  meat  diet, 
omitting  potatoes,  and  at  the  end  of  six  months  he 


Chap,  VI.]  Diet  in  Obesity.  453 

weighed  16  stones,  6^  lbs.,  and  had  therefore  lost 
4  stones.  For  four  months  he  was  kept  on  a  strictly 
nitrogenous  diet,  and  for  six  weeks  on  ordinary  diet, 
without  potatoes.  This  I'eduction  was  maintained  on 
ordinary  diet,  with  the  avoidance  of  beer*  and  with 
draughts  of  water. 

The  success  of  this  system  is  accounted  for  by  the 
supposition  that  the  patient  supplies  the  necessaiy 
hydi'ocarbons  and  carbohydrates  (absent  in  his  diet) 
from  his  own  store — that  he  consumes  his  own  fat. 

It  is,  of  course,  necessary  in  the  application  of 
this  method  to  secure  the  hearty  co-openition  of  the 
j)atient.  Tliis  diet  is,  we  think,  improved  by  the 
addition  of  some  fresh  green  vegetables,  such  as 
watercress,  lettuce,  and  the  like.  It  is  by  no  means 
of  universal  applicability,  but  seems  to  be  especially 
useful  in  those  cases  of  obesity  which  are  due  to  over- 
feeding. It  must,  however,  be  recognised  that  some  of 
the  most  striking  results  in  the  reduction  of  fat  have 
been  observed  in  the  employment  of  this  method. 

Ebstein's  method  has  the  recommendation,  no 
doubt,  of  diminishing  the  desire  for  food,  and  is 
applicable  .to  the  strong  and  vigorous  with  large 
appetites.  The  deficiency  in  albuminates  and  excess 
of  futs  render  it  unsuited  to  feeble  subjects  with 
weak  digestions,  and  it  is  not  a  system  likely  to 
become  popular. 

Schweninger's  system  is  fairly  applicable  to  many 
cases;  but  the  absolute  exclusion  of  all  drink  during 
meals,  although  it  no  doubt  has  the  effect  of  diminish- 
ing considerably  the  desire  to  eat  in  excess,  disagr*ees 
with  many  persons  of  feeble  digestion,  and  should  not 
be  incautiously  prescribed. 

In  Banting's  system  there  is  too  rigorous  an 
exclusion  of  fats,  which  are  essential  to  healthy 
nutrition. 

Certain  cases  undoubtedly  do  well  with  a  strict 
limitation  of  beverages;  others,  on  the  contrary,  as 
pointed  out  by  G.  See,  are  better  for  the  free  use 
*  Lancet,  July  15th,  1893. 


454  Food  in  Disease.  [Panii. 

of  hot,  diluent  drinks,  and  these  are,  especially,  the 
gouty  cases  with  a  tendency  to  defective  elimination. 
It  is  in  such  cases  that  a  teacupful  or  more  of  hot 
water  taken  half  an  hour  before  eacli  meal  and  at 
bedtime  answers  well,  and  enables  them  to  do  with 
much  less  fluid  at  mealtimes  than  is  usually  taken. 

The  two  principal  objects  of  all  these  methods  is, 
Jirsl,  to  make  the  corpulent  person  consume  the  excess 
of  fat  deposited  in  his  body  by  restricting  the  food- 
suj)ply,  or  augmenting  its  combustion  by  incicased 
physical  exercise  or  other  means ;  and,  second,  to 
establish  a  dietary  which  shall  prevent  its  re- 
accumulation. 

None  of  the  methods  described  is  appropriate  to 
the  treatment  of  all  cases  of  obesity  indiscriminately, 
while  any  one  of  them  may  prove  successful  in  suitable 
instances. 

In  conclusion,  the  following  is  the  method  which 
we  reconniiend  to  be  generally  adopted :  a  very  careful 
examination  should  be  made  of  each  case  in  order 
to  ascertain  the  presence  or  absence  of  any  organic 
disease,  especially  of  any  cardiac  degeneration,  and  if 
we  are  satisfied  that  the  obesity  is  not  secondary  to  any 
other  morbid  state,  or  associated  with  any  general 
degeneration  of  organs,  we  may  proceed  with  conhdenco 
to  prescribe  an  appropriate  regime. 

The  albuminates  in  the  form  of  animal  food  should 
be  strictly  confined  within  the  limits  necessary  for 
healthy  nutrition.  Farinaceous  and  all  starchy  foods 
should  be  reduced  to  a  minimum.  Sugar  should  be 
entirely  prohibited.  A  moderate  amount  of  fat,  for 
the  reasons  given  by  Ebstein,  may  be  allowed  in  some 
instances. 

Only  a  small  quantity  of  fluid  should  be  ])einiitted 
at  meals ;  but  enough  should  be  allowed  to  aid  in  the 
solution  and  digestion  of  the  food. 

Hot  water,  or  warm  aromatic  beverages,  may  be 
taken  freely  between  meals,  towards  the  end  of  the 
digestive  process,  especially  in  gouty  cases,  on  account 
of  their  eliminative  action. 


Chap.  VI.]  Diet  in  Obesity.  455 

No  beei",  poller,  or  sweeb  wines  of  any  kind  are  to 
be  taken ;  no  spirits,  except  in  very  small  quantity.  It 
should  be  generally  recognised  that  the  use  of  alcohol 
is  one  of  the  most  common  provocatives  of  obesity. 

A  little  hock,  still  Moselle,  or  light  claret  with 
some  alkaline  table-water  is  all  that  should  be  allowed. 
The  beneticial  effects  of  such  a  diet  will  be  aided  by 
abundant  exercise  on  foot,  and  by  the  free  use  of 
saline  purgatives,  so  that  we  may  insure  a  complete 
daily  unloading  of  the  intestinal  canal. 

It  is  only  necessary  to  mention  a  few  other  details. 
Of  animal  foods,  all  kinds  of  lean  meat  may  be  taken, 
poultry,  game,  fish  (eels,  salmon,  mackerel  are  best 
avoided),  eggs. 

Meat  should  not  be  taken  more  than  twice  a  day, 
and  not  more  than  6  oz.  of  cooked  meat  at  a  time. 

Two  lightly  boiled  or  poached  eggs  may  be  taken 
at  one  other  meal,  or  a  little  grilled  tish. 

Bread  should  be  toasted  in  thin  slices  and  com- 
pletely, not  browned  on  the  surface  merely. 

Soups  should  be  avoided,  except  a  few  table- 
spoonfuls  of  clear  soup  at  dinner. 

Milk  should  be  avoided,  unless  skimmed  or  when 
taken  as  the  chief  article  of  diet.  All  milk  and 
farinaceous  puddings  and  pastry  of  all  kinds  are 
forbidden. 

Fresh  vegetables  and  fruits  are  permitted. 

It  is  important  to  bear  in  mind  that  the  actual 
quantity  of  food  permitted  must  have  a  due  relation 
to  th;  physical  development  of  the  individual,  and 
thot  '.vhat  would  be  adequate  in  one  case  might  be 
altog|;ther  inadequate  in  the  case  of  another  person  of 
lai'ger  physique. 

Note  on  the  "Salisbuuy''  Method. 

Wo  have  spoken,  in  connection  with  the  Treatment  of 
Obesity,  of  the  "Salisbury  "  method  of  feeding.  This  method, 
however,  is  not  hmitei  to  the  treatment  of  obesity,  but  is 
considered  to  be  widely  applicable  to  many  dyspeptic  states, 
and  it  needs,  we  think,  a  little  further  e.xposiiion. 

The  essential  idea  of  this  system  wbeu  strictly  appUed  is  to 


456  Food  in  Disease.  [Partii. 

limit  the  food  and  drink  (0  thu  lean  of  meat,  prefeiably  toef, 
and  an  abundance  of  hot  wat(  r.  This  reduces  the  problem  of 
digr-stion  to  an  extreme  simplicity,  and  its  laudable  objtct  ia 
lo  require  of  the  enfeebled  or  disoidertd  digestive  organs  one 
k.nd  of  w -irk  only,  viz.  the  digestion  of  uifrogenous  food  in  its 
most  readily  ass'milablc  form.  It  requires  also,  and  this  is  a 
condition  of  great  imporlanco,  tha'.  the  nuat  should  be  minced 
or  finely  divided  in  a  speci  il  manner,  as  we  shall  see  ;  so  that 
tliis  work  of  extreme  subdivision  is  done  out  of  the  body,  and 
the  work  of  digest'on  thereby  greatly  lightened. 

The  merit  of  this  diet  in  the  mind  of  the  inventor  is  that  it 
gets  lid  of  all  "fermentative  "  food-,  as  he  terms  most  of  the 
Cvmmon  aiticles  of  ordinary  diet.  The  large  quantities  of 
hot  water  which  it  is  considere  I  necessary  to  consume  act,  of 
course,  as  a  solvent  and  eliminative  agent;  bo  that  whatever  excess 
of  nitrogenous  wa-te  may  resu't  from  this  highly  auimalised 
legime  is  readily  carr'ed  away  by  the  secretions  of  the  ]iver 
and  kidneys,  the  eliminative  functions  of  whi  h  (as  well, 
doubtless,  as  that  of  the  skin)  are  powerfully  promoted  by 
this  large  ingestion  of  hot  water. 

In  canying  out  this  method  it  is  usual  to  begin  with  and 
for  a  time  to  adhere  to  the  foUowin.?  rule : — 

The  diet  to  be  restricted  to  animal  f.iod,  minced — preferably 
beef — and  four  pints  of  hot  or  warm  water  to  be  drunk  daily — 
a  pint  an  hour  and  a  half  before  each  of  the  three  meals,  and 
the  last  pint  hilf  an  hour  before  bedtime  ;  the  idea  being  that 
the  stomach  sho  aid  be  empty  at  the  time  of  drinking  the  hot 
water,  so  that  it  may  cleanse  or  wash  clean  the  gastric  mucous 
membrane.  The  temperature  of  the  water  should  be  just 
pleasantly  hot — about  100°  to  120°  F. — and  it  is  permitted  to 
aJd  to  the  water,  if  desired,  a  little  sal  volatile,  or  a  pinch  of 
talt,  or  a  squeeze  of  lemon- j  uice,  or  a  little  clear  tea ;  it  should 
be  sipped  slowly,  not  swallowed  quickly.  Those  who  find  a 
difficulty  in  drinking  so  much  water  at  a  tima  maj'  begin  with 
a  teacupful  and  slowly  increase  the  amount  to  the  full  pint. 
The  times  aj^pointed  as  best  for  the  meils  are  8  a.m  ,  1  p.m., 
and  6.30  p.m.  (five  hours  between  each  m  al).  It  must  not  be 
understood  that  this  is  suggested  as  a  permanent  diet;  it  is 
only  intended  to  be  adopted  "  while  tlie  necessity  for  it  lasts." 

The  meat  is  first  minced  and  then  cooked,  as  we  shall 
immediat'-dy  describe.  It  is  coutended  that  this  mince  gives 
the  "  very  greatest  nourishment  along  with  the  least  possible 
strain  and  labom-  to  the  stomach  ;  it  is  digested  and  assimilated 
with  great  ease  and  rapidity." 

The  only  food  at  breakfast,  dinner,  an  1  supper  is,  at  fii-st, 
to  b3  minced  beef,  and  for  beverages  clear  tea  or  cofEco  (no 
milk  or  sugar),  or  beef-tea.  Those  who  crave  for  something  to 
chew  may  have  a  small  piece  of  nicely-broiled  tender  steak 
along  with  the  mince,  or  "  a  bit  of  broilf  d  beef-cake."' 


Chap.  VI.)       The  "Salisbury^'  Method.  457 

With  the  minced  beef  it  is  permitted  to  add  such  condiments 
as  black  pepper,  salt,  and  mustard,  and  Chutnee  sauce  is  also 
approved  of;  but  no  vegetable  is  to  be  taken,  except  n  little  raw 
or  well-cook- d  celery  (we  cannot  see  whj'  this  permission 
should  not  be  extended  to  lettuce  and  watercresscs). 

If,  owing  to  the  rajjidity  with  which  this  minced  meat 
is  digested,  any  hungry  cravings  occur,  especially  in  the  night, 
they  maybe  allayed  by  a  few  mouthfuls  of  meat-soup  or  a  little 
mince,  or  both. 

As  to  the  quantity  of  minced  meat  consumed,  "  each 
patient's  own  digestive  power  must  be  his  law."  He  may  begin 
with  1  to  2  oz.  at  each  meal,  and  increase  gi-adually  to  3  to  4 
tz.,  and  then  to  5  to  6  oz.,  and  then  to  8  oz.  or  more  if  it  is 
well  and  easily  digested. 

"  One  pound  of  good  lean  beef  or  mutton  at  a  meal  is  as 
much  as  any  male  patient,  in  best  condition,  should  eat."  In 
addition  to  this,  if  still  hungry,  he  may  be  allowed  to  take  the 
ichitcs  of  one  or  two  eggs  between  meals— beaten  up  or  lii^litly 
poached — up  to  half  a  dozen  a  day.  The  effect  of  this  diet  is 
usua'ly  to  induce  a  considerable  loss  of  weight  and  a  temp  rarv 
feeling  of  weakness  in  some  cases.  But  the  loss  is  chiefly 
useless  lumber,  and  the  strength  is  soon  recovered  and 
augmented.  Some  simple  aperient  may  also  be  ue<>dod  owing 
to  the  small  amount  of  fajcal  residu ;  from  this  diet ;  it  is 
recommended  that  a  teasjoonful  of  fluid  extract  of  senna  or 
rhubirb  in  a  little  watc  be  taken  at  bedtime. 

An  occasional  change  is  allowed  fi'om  mince  to  tender  undei'- 
cut  of  sirloin,  whole  steaks,  or  nicely  broiled  tender  mutton  — 
of  which  the  lean  only  should  be  eaten,  freed  from  skin,  fat, 
and  connective  tissue.  Very  little  fluid  should  be  taken  at 
meal-times,  and  very  little  will  be  needed,  as  thirst  will  be 
quenched  beforehand  by  the  large  draughts  of  hot  water. 

A  little  hot  water  may  be  sipped  at  meals,  or  good 
beef-tea. 

After  a  time  the  following  adjuncts  are  allowed  (minced, 
however,  in  most  cases  before  cooking) :  — Mutton,  lamb, 
sweetbread,  poultry,  whitj  fish,  soft-boiled  or  poached  eggs 
baked  potato,  well-boiled  rice  or  macaroni,  wheaten  bre  id  (>tale 
or  roasted  crisp  in  an  oven),  adhering,  however,  to  what  is 
termed  a  two-third  diet,  viz.  two  mouthf  uls  of  meat  to  one  of 
other  kinds  of  food. 

As  relishes,  it  is  allowable  to  bike  a  small  bit  of  cheese,  a 
baked  apple,  stewed  prunes,  or  fresh  fruit. 

The  above  is  a  brief  summary  of  the  chief  requirements  of 
the  Salisbury  system,  to  which  wo  add  the  instruitions  for 
prei>aring  the  minced  beef  aud  the  "  beef  cakes  " 

We  are  disposed  to  regard  this  method  as  having  much  to 
recommend  it  in  many  cases  and  as  very  well  alaptcd,  with  .1 
few  modifications 'in  thu  dinttion   of  adinittiu'   more   fresh 


458  Food  in  Disease.  [Partii. 

green  vegetable  s  or  fruit  from  the  start,  to  the  reduction  of 
corpulency  in  many  persons. 

Its  fault  lies  in  being  too  absolute  and  exclusive  for  the 
majority  of  patients  in  its  strict  form. 

The  following  are  the  directions  given  for  cooking  the 
minced*  beef: — '"A  slice  or  steak  from  the  top  side  of  the 
round  ■vrithout  fat  is  the  proper  part.  The  meat  to  be  cut 
into  strips,  and  all  skin,  connective  tissues,  gristle,  fat,  etc., 
as  far  as  possible  scraped  away  with  a  sharp  knife.  The  meat 
is  to  be  j.ut  through  the  mincer  at  least  twice.  The  pulp 
must  then  bo  xcell  beaten  up  in  a  roomy  saucepan  with  cold 
water,  or  plain,  well-skimmed  beef-tea,  in  which  no  vegetables 
have  ben  cooked,  to  somewhat  the  consistency  of  cream. 
The  right  proportion  is  about  one  teaspoonful  of  liquid  to 
one  ounce  of  pulp.  Pepper  (black)  and  salt  to  taste.  The 
mince  must  then  be  stirred  briskly  with  a  wooden  spoon  the 
whole  time  it  is  cooking,  over  a  very  slow  Ji re  or  on  a  cool  part  of 
a  covered  range  till  perfectly  hot  throuyh  and  the  red  colour 
disappears.  It  will  probably  take  from  twenty  minutes  to  half 
an  hour  to  cook  if  done  as  slowly  and  carefully  as  it  should  be; 
and  the  stirring  must  be  continued  all  the  time,  so  that  the 
mince  may  never  settle  at  the  bottom  of  the  saucepan,  but  be 
constantly  turned  up.  It  must  be  thorouglily  cooked  through, 
but  never  appi-oach  simmering  even.  When  done,  it  should  be 
a  soft,  smooth,  stiff  puree,  of  the  consistency  of  a  thick  paste 
without  any  lumps  or  hard  bits.  It  is  always  to  be  served  in  a 
very  hot  howl  and  eaten  with  a  teaspoon.  Almost  every 
patient  is  allowed  at  the  first  two  meals  a  stick  of  raw  or  very 
nicely  stewed  celery." 

The  "  beef-cakes  "  are  directed  to  be  made  thus  : — 

"  Take  minced  beef  pulp,  season  it  with  black  pepper  and 
salt,  and  with  two  forks  form  it  lightly  and  quickly  into  round 
flat  cakes  about  half  an  inch  thick,  and  grill  them  over  a  clear 
bat  moderate  fire,  turning  the  griller  (an  American  griller)  once 
every  minute  till  the  cakes  are  lightly  broiled  through.  They 
take  about  five  or  six  minutes,  and  must  not  be  overcooked. 
The  pulp  must  be  looselyva&Ae  up,  not  hard  or  tightly  pressed." 

*  The  mincer  recommended  is  named  "The  Enterprise,"  to  be 
obtained  of  the  "Enterprise  Hardware  Cojoijany,"  bti  dud  88, 
Dale  Street.  Liverpool. 


459 


CHAPTER    VII. 

DIET    IN    ANEMIA,    CHLOKOSIS,    NEURASTHENIA,    AND 
ALLIED    DISTURBANCES    OF    NUTRITION. 

The  due  and  adequate  nutrition  of  all  the  organs  and 
tissues  of  the  body  and  their  maintenance  in  a  stable 
state  of  normal  functional  activity  are  essentially 
de[)ondent  upon  the  integrity  of  the  circulating  fluid, 
the  blood,  which  brings  to  each  of  them  the  elements 
necessary  for  the  support  of  their  structure  and  the 
development  of  their  functional  energies.  Any  defect 
in,  or  deviation  from,  the  normal  composition  of  the 
blood  will,  therefore,  tend  to  disturbance  and  deteriora- 
tion in  the  condition  and  functions  of  all  the  organs 
of  the  body  ;  and  it  is  obvious,  and  needs  no  demonstra- 
tion, that  the  reception,  digestion,  and  assiniilation  of 
a  sufficient  quantity  of  suitable  food  are  requisite  to 
maintain  the  needful  healthy  quality  and  quantity  of 
the  blood,  and  to  restore  them  when  lost. 

It  is  clear,  then,  that  the  moibid  states  of  the 
blood  known  as  amemia  and  chlorosis  cannot  be 
successfully  remedied  without  due  attention  to  diet. 

Those  troublesome  states  of  disturbed  health  and 
nutrition,  commonly  described  as  cases  of  neurasthenia 
or  nervous  exhaustion,  aregenerally  associated  with  an 
aniemic  condition,  and  their  dietetic  treatment  may  be 
conveniently  considered  in  this  chapter. 

In  some  of  the  latter  morbid  affections  it  seems 
not  unlikely  that  the  defective  nutrition  observed  in 
them  may  be,  in  part,  due  to  original  disturbances  in 
the  functional  activity  of  the  cellular  elements  brought 
about,  directly  or  indirectly,  by  nervous  influences, 
and  that  the  altered  condition  of  the  circulating  fluid 
which  ensues  may  be  referred,  primarily,  to  some 
disorder  of  the  nervous  system  ;  hence,  no  donbt,  the 


460  Food  in  Disease.  [Panii. 

necessity  of  directing  i-emedial  measures  to  the  restora- 
tion of  a  healthy  tone  in  the  nervous  system  in  tliose 
cases,  and  the  success  which  has  attended  the  applica- 
tions of  such  methods  in  combination  with  appropriate 
dietetic  expedients. 

Amongst  the  various  causes  of  anaemia  or  hydraemia 
— by  which  is  meant  an  alteration  in  the  composition 
of  the  blood,  so  that  it  becomes  poorer  in  red  corpuscles 
and  more  watery — a  defective  or  unsuitable  supply  of 
food  must  be  regarded  as  one  of  the  most  frequent. 

It  has  been  proved  that  with  a  diet  composed  of 
exclusively  non-nitrogenous  food  the  percentage  of 
haemoglobin  in  the  blood  undergoes  a  notable 
diminution,  while  it  is  augmented  by  a  diet  rich 
in  albuminates. 

It  is  certain  that  much  of  the  chlorosis,  antemia, 
and  associated  nervous  disturbances  observed  amongst 
young  girls  at  the  age  of  puberty  are  referable  to 
improper  or  insufficient  feeding  at  school,  together 
with  the  imposition  of  educational  tasks  to  which 
they  are  unequal.  Defective  nutrition  from  in- 
sufficient food,  combined  with  educational  strain, 
we  are  disposed  to  regard  as  responsible  for  the 
breakdown  in  health  observed  in  many  young  persons 
of  feeble  or  sensitive  organisation  at  this  time  of 
life. 

It  is  too  commonly  forgotten  by  those  who  are 
charged  with  the  caie  and  education  of  youth  that 
growth  and  develo])ment,  which  are  often  exceedingly 
rapid  in  the  female  at  the  period  we  refer  to,  can 
only  take  place  by  the  agency  and  at  the  exi)ense  of 
the  nutrient  fluids  and  their  active  elements,  es- 
pecially the  red  corpuscles,  and  that  these  require  a 
frequent  and  abundant  supply  of  nutritious  food 
for  their  constant  regeneration ;  while  the  processes 
of  digestion  and  assimilation  to  be  carried  on  with 
wholesome  and  needful  activity  require  a  certain 
repose  of  the  nervous  system  which  is  inconsistent 
with  severe  mental  tasks. 

The  more  acute  forms  of  anaemia  may  be  caused  by 


Chap. VII.]  The  Anemic  State.  461 

hsemoiThages,  or  be  the  result  of  severe  illnesses,  and 
in  the  latter  case  considerable  emaciation  generally 
accompanies  it. 

With  suitable  food  recovery  is  very  rapid  in  most 
of  these  cases,  and  a  moderate  loss  of  blood  is  soon 
made  up ;  the  fluid  part  is,  however,  more  quickly 
restored  than  the  corpuscles. 

In  some  chlorotic  females  it  has  been  said  that 
the  heart  and  blood-vessels  are  abnormally  small,  so 
that  they  suffer  from  a  congenital  weakness  in  the 
blood-forming  and  blood-propelling  apparatus;  in 
such  instances,  not  only  must  great  care  be  observed 
in  the  regulation  of  the  diet,  but  all  the  organs  of 
the  body  should  be  safeguarded  from  undue  strain  or 
any  over-exertion. 

In  all  cases  of  anaemia  not  only  must  we  see  that 
the  supply  of  food  is  adequate  and  its  quality  suit- 
able, but  we  must  also  watch  over  its  digestion  and 
assimilation.  The  functional  disturbances  which  are 
associated  with  poor  and  watery  blood  are  especially 
marked  in  the  digestive  organs,  the  secretions  of 
which  become  defective  both  in  quantity  and  quality, 
and  dyspeptic  troubles  are,  therefore,  common  accom- 
paniments of  the  anaemic  state.  Disturbances  of  the 
nervous  system  from  an  imperfect  blood-supply  are 
likewise  frequent,  such  as  languor,  depression  of 
spirits,  giddiness,  headache,  neuralgia,  etc. ;  while  the 
whole  muscular  system  is  enfeebled  from  defective 
nutrition,  so  that  muscular  fatigue  and  aching  of  the 
muscles  are  often  induced  by  comparatively  slight  exer- 
tion ;  and  in  no  muscle  is  this  more  evident,  or  more 
distressing,  than  in  the  heart  muscle,  which  shows  its 
distress  by  palpitation  on  the  slightest  exertion,  by  a 
tendency  to  fainting,  and  not  infrequently  by  becoming 
sensitive  to  pain — as  can  be  readily  proved  by  pressing 
with  the  finger  in  the  intercostal  space  over  the 
apex  of  the  heart,  when,  in  many  cases  of  chronic 
anaemia,  a  distinct  sense  of  pain  and  tenderness  in 
the  cardiac  muscle  can  be  excited.  (Edema  of  the 
feet  and  ankles  is  also  a  symptom  often  present  in 


462  Food  in  Disease.  [Partii. 

ansemic  states,  due  to  the  disturbances  in  the 
functions  of  the  circulatory  organs.  Germain  See 
appears  to  us  singularly  at  fault  in  denying  the 
possibility  of  oedema  occurring  as  a  consequence  of 
simple  anpemia,  and  concluding,  as  he  does,  that  when 
oedema  of  the  feet  is  observed  in  cases  of  chlorosis,  it 
is  due  to  a  co-existing  valvidar  cardiac  lesion,  and 
especially  to  mitral  stenosis.* 

It  has  been  noticed  that  in  anaemic  persons  the 
conditions  of  normal  metabolism  are  somewhat 
moflified,  and  especially  that  there  is  increased  meta- 
bolism of  the  albuminates,  .so  that  the  excretion  of 
urea  is  increased  ;  and  we  have  ourselves  noted  the 
high  specific  gravity  of  the  urine  (1028  to  1035)  in 
some  of  these  cases,  from  the  presence  of  a  great 
excess  of  urea. 

The  metabolism  of  fat  appears,  however,  to  be 
diminished,  and  it  may  often  be  observed  in  anaemic 
persons  that  while  their  muscles  are  feeble  and 
wasted,  they  wear  a  generally  plump  aspect,  from 
the  presence  of  a  considerable  amount  of  adipose 
tissue.  This  has  been  referred  to  defective  oxygena- 
tion from  the  decrease  in  red-blood  corpuscles,  the 
carriers  of  oxygen,  and  consequent  imperfect  com- 
bustion of  the  hydrocarbons  and  carbohydrates. 

From  these  preliminary  considerations  we  are  able 
to  deduce  the  following  indications  for  the  dietetic 
treatment  of  cases  of  anaemia  and  chlorosis  : — 

1.  The  food  should  contain  the  elements  needed 

for  the  restoration  of  the  deficient  blood 
corpuscles,  and  of  the  general  normal  in- 
tegrity of  the  circulating  fluid. 

2.  It  should  be  directed  to  restoring  tone  to  the 

enfeebled  muscles,  and  especially  to  the 
cardiac  muscle. 

3.  It  should  be  supporting  and  soothing  to  the 

exhausted  and  irritable  nervous  system. 

*  Germain  See,  "Regime  Alimentaire:    Des  Cblorotiques  et 
Anemiques,"  p.  416. 


Chap.  VII.]  Diet  in  Anemia.  463 

4.  It  should  be  of  a  kind,  and  in  a  mode  of 
preparation,  which  renders  it  easily  and 
quickly  appropriated  by  the  organs  of  di- 
gestion and  assimilation^processes  especially 
languid  and  feeble. 

At  the  outset  of  the  treatment,  res^  of  the  exhausted 
organism  should  be  particularly  enforced.  The  tend- 
ency to  urge  the  young  who  are  feeble  and  anfemic 
to  take  abundant  exercise,  and  to  make  them  follow 
the  same  mode  of  life  as  their  healthy  associates, 
cannot  be  too  strongly  condemned.  It  interferes  with 
the  success  of  all  our  remedial  measures.  To  insist, 
as  is  so  often  done,  that  a  chlorotic  young  girl  shall 
rise  at  the  same  hour  in  the  morning  as  the  rest  of  the 
family,  pai'tuke  of  the  same  meals  at  the  same  hours, 
engage  in  the  same  pursuits,  and  conduct  herself  as  if 
she  were  strong  and  well,  is  most  unreasonable  and 
harmful. 

Instead  of  such  a  routine,  she  should  be  given  her 
breakfast  in  bed  ;  she  should  not  be  allowed  to  rise 
much  before  mid-day  ;  she  sliould  be  encouraged  to 
rest  as  much  as  possible,  in  the  recumbent  position, 
in  an  airy  apartment,  or  be  swung  in  a  hammock 
during  fine  weather  in  the  open  air.  As  soon  as 
some  improvement  in  the  blood  condition  is  observ- 
able, and  some  return  of  healthy  functional  activity  is 
apparent,  a  moderate  amount  of  gentle  exercise  may 
be  permitted,  and  this  should  be  gradually  increased 
with  each  increasing  gain  in  health  and  strength. 

The  food  given  at  first  should  be  in  small  or 
moderate  quantity,  so  as  not  to  overtax  the  feeble 
digestive  powers,  and  in  a  form  that  can  be  readily 
digested. 

Milk,  skimmed  if  necessary,  is  most  useful  when  it 
is  easily  digested  ;  but  it  must  not  be  {persevered  with 
when  it  is  digested  with  difficulty,  and  is  on  tlat 
account  distasteful  to  the  patient.  A  good  substitute 
for  milk  is  a  mixture  of  equal  parts  of  cream  and  hot 
water  (2  oz.  of  each),  to  which  a  little  bicarbonate  of 


464  Food  in  Disease.  [Partii. 

soda  and  a  teaspoonful  of  brandy  or  sal  volatile  may 
be  added.  This  is  a  good  food  to  begin  the  day  with. 
All  forms  of  animal  food,  prepared  in  a  manner  easy 
of  digest  ion,  are  useful  and  appropriate.  Raw  or 
slightly-cooked  meat,  pounded  or  scraped,  and  mixed 
with  agreeably  flavoured  consomme  or  meat  broth,  or 
made  into  sandwiches,  or  mixed  with  chocolate  or 
Burgundy  and  water,  or  given  in  any  wholesome  form 
approved  of  by  the  patient,  is  of  great  value  as  a  blood 
restorer. 

G.  See  states  that  he  has  often  cured  cases  of 
chlorosis  without  iron,  or  after  iron  has  failed,  by  the 
administration  of  400  grammes  (about  14  oz.)  of  raw 
meat  daily,  together  with  hydrotherapy  ;  and  he  con- 
siders those  two  means  as  indispensable  in  the  treat- 
ment of  dyspeptic  chlorotics  who  cannot  take  iron,  and 
the  former  also  in  those  cardiac  cases  which  cannot 
tolerate  either  iron  or  hydrotherapy.* 

The  digestive  power  for  nitrogenous  or  other 
foods  must  be  carefully  watched,  and,  if  necessary, 
aided  by  the  addition  of  some  appropriate  digestive 
ferment.  A  teaspoonful  of  Liquor  Pepticus  or  three 
or  four  grains  of  pepsin  may  be  given  with  each 
meat  meal. 

Peptonised  milk — a  breakfastcupful  twice  or  three 
times  a  day — will  be  u.seful  when  unprepared  milk 
disagrees. 

To  obviate  the  tendency  to  constipation,  well- 
made  whole-meal  bread  may  be  given,  watching  again 
carefully  for  any  signs  of  indigestion  which  it  is  apt 
occasionally  to  provoke.  For  the  same  purpose,  oat- 
meal porridge  may  be  taken  at  breakfast,  and  some 
fruit  compCite. 

Green,  fresh  vegetables,  especially  in  the  form  of 
purees,  are  also  to  be  recommended  for  the  same  pur- 
pose. Macaroni,  vermicelli,  polenta,  and  the  various 
Italian  pastes,  cooked  with  meat-juice  or  gravy,  are 
excellent. 

Animal  albuminates  should  predominate  in  the 
*  ''L'Hygi^ne  Alimentaire, "  p.  420. 


Chap.  VII.]  Diet  in  Anemia.  465 

diet  at  first,  given  in  quantity  proportionate  to  the 
digestive  capacities.  Some  easily  digested  fat — par- 
ticularly in  cases  where  there  has  been  loss  of  fiesh  — 
should  soon  be  added ;  indeed,  progress  in  blood- 
making  will  often  fail  to  take  place  until  some  diges- 
tible fat  be  added  to  the  dietary.  A  dessertspoonful 
of  cod-liver  oil  once  a  day  will  frequently  sufiice,  and 
should  be  ordered  when  it  is  not  objected  to.  When 
this  is  objected  to,  some  other  form  of  fat  should  be 
introduced  into  the  daily  dietary. 

Butter  is  one  of  the  best ;  so  is  cream.  They 
may  be  Jigreeably  mixed  with  some  farinaceous  food 
in  the  form  of  light  puddings,  and  served  with  fruit- 
sauce  or  jelly.  Broiled  fat  bacon  at  breakfast  is,  with 
many  persons,  an  easily-digested  form  of  fat. 

Eggs  in  any  form  are  a  very  suitable  food,  as 
they  present  a  concentrated  and  generally  easily- 
digested  foi'm  of  nutriment  rich  in  iron.  One  or 
two  egg.s,  beaten  up  with  a  little  boiling  water,  with 
or  without  milk,  to  which  a  little  sugar,  nutmeg  or 
other  spice,  and  a  tablespoonful  of  brandy  may  be 
added,  are  an  excellent  and  nutritious  restorative  in 
those  cases  of  anaemia  with  cardiac  feebleness  and 
loss  of  appetite. 

Bauer  *  is  decidedly  in  favour  of  a  liberal  propor  • 
tion  of  nitrogenous  food  in  the  dietary  of  aniemic 
patients.  "It  is  probable,"  he  says,  "that  the  re- 
production of  the  most  essential  components  of  the 
blood,  especially  of  the  red  corpuscles,  would  be 
greatly  favoured  if  relatively  more  albumen  were 
contained  in  the  food  of  such  patients  than  is  proper 
under  physiological  conditions." 

Anajmia  in  infants  and  young  children  often  arises 
from  an  insufficient  amount  of  fresh  animal  food — i.e. 
fresh  milk  or  some  equivalent  for  it.  Anaemia  is 
common  in  all  starch-fed  children  and  in  those  brought 
up  on  purely  vegetable  foods  ;  and  it  would  seem  that 
desiccated  milk  loses  some  of  the  antiscorbutic  quality 

*  "Dietary  of  the  Sick:  Diet  in  An»:mia  and   HydriKmia," 
p.  275. 

E  B 


466  Food  in  Disease.  [Panii. 

of  fresh  milk,  and  therefore  its  capacity  for  making 
red  blood.  In  these  cases  the  best  remedy  is  to  add 
to  the  milk  (or  other  food)  some  raw  meat  juice  or 
meat  pulp,  the  haemoglobin  in  which  is  probably  used 
directly  in  the  formation  of  new  red-blood  corpuscles. 

It  is  very  necessary,  in  these  cases,  that  great 
attention  should  be  given  to  the  manner  of  ]>reparing 
and  serving  the  food  prescribed,  so  as  to  make  it  as 
palatable  and  attractive  as  possible,  for  in  a  great 
number  of  these  patients  we  have  to  contend  with 
entire  loss  of  appetite  and  indisposition  to  take  food  ; 
and  our  chief  resources,  at  first,  will  be  found  in 
pleasantly-flavoured  fluid  or  semi-fluid  foods,  which 
can  be  swallowed  without  previous  mastication.  Con- 
diments in  moderate  amount  are  very  useful  to  render 
the  food  agreeable;  and  a  certain  amount  of  wine — 
of  which,  perhaps,  a  good  sound  Burgundy  is  the  best 
— should  be  given,  and  is  useful  as  a  stimulant  to  the 
circulatory  and  a  sedative  to  the  nervous  systems. 
We  have  found  porter  or  stout  useful  and  well  borne 
in  some  instances,  and,  if  taken  at  bedtime  with  a 
little  bread  and  butter  or  a  biscuit,  it  will  frequently 
have  the  effect  of  inducing  sleep  in  cases  complicated 
with  insomnia. 

It  has  been  recommended,  on  the  authority  of 
Moleschott,  that  chlorotics  should  partake  freely  of 
salt  with  their  food,  on  the  ground  that  it  favours, 
directly  and  indirectly,  the  restoration  of  the  blood 
corpuscles  as  well  as  the  blood  plasma. 

Bauer's  caution  against  the  excessive  use  of 
vinegar,  as  causing  "a  high  degree  of  anajmia  and 
emaciation,  since  the  acid  lessens  the  alkalinity  of  the 
blood  and  the  number  of  the  blood  corpuscles,"  has 
already  been  quoted. 

For  the  appropriate  dietetic  and  other  manage- 
ment of  those  cases  of  neurasthenia  or  nervous 
exhaustion  in  which  the  general  nutrition  is  so 
gravely  affected  that  quite  ]ihenomenal  states  of 
emaciation  and  muscular  feebleness  are  observed  in 
connection   therewith,    we   are   mainly   indebted    to 


ChAp.  VII.]        Diet  in  Neurasthenia.  467 

Dr.  Weir  Mitchell.  These  cases  cannot,  however, 
be  restored  to  health  by  appropriate  food  alone,  but 
other  curative  agencies  have  to  be  simultaneously  and 
systematically  employed.  These  are  complete  isola- 
tion, rest  in  bed,  and  the  regular  application  of 
massage  and  electricity.  To  use  Weir  Mitchell's  own 
words,  the  method  consists  of  "  a  combination  of 
entire  rest  and  of  excessive  feeding,  made  possible  by 
passive  exercise  obtained  through  the  steady  use  of 
massage  and  electricity."  *  He  insists  on  the  inti- 
mate association  between  the  gain  and  loss  of  fat  and 
the  gain  and  loss  of  blood  corpuscles.  "  The  loss  of 
fat  .  .  .  nearly  always  goes  along  with  conditions 
which  impoverish  the  blood  ;  and,  on  the  other  hand, 
tlie  gain  of  fat,  up  to  a  certain  point,  seems  to  go 
hand  in  hand  with  a  rise  in  all  other  essentials 
of  health,  and  notably  with  an  improvement  in  the 

colour  and  amount  of  the  red  corpuscles To 

gain  in  fat  is  nearly  always  to  gain  in  blood."  It 
may  also  be  well  to  let  Dr.  Weir  Mitchell  himself 
describe  the  cases  to  which  he  considers  his  method 
especially  applicable.  They  are  "people  who  are 
kept  meagre,  and  often  also  anaemic,  by  constant 
dyspepsia  in  its  varied  forms,  or  by  those  defects  in 
assimilative  processes  which,  while  more  obscure,  are 
as  fertile  parents  of  similar  mischief ;  .  .  .  .  that 
large  group  of  women  especially,  said  to  have  nervous 
exhaustion,  or  who  are  defined  as  having  spinal  irrita- 
tion, .  .  .  cases  in  which,  besides  the  wasting  and 
anaemia,  emotional  manifestations  predominate,  and 
who  are  then  called  hysterical,  whether  or  not  they 
exhibit  ovarian  or  uterine  disorders  ;  .  .  .  women 
who  have  lost  flesh  and  grown  colourless,  but  have 
no  hysterical  tendencies,  .  .  .  hopelessly  below  the 
standard  of  health,  and  subject  to  a  host  of  aches  and 
pains,  without  notable  organic  disease." 

The  large  amounts  of  food  given  in  this  method, 
while  the  patient  takes  no  exercise,  are  absorbed  and 

*  "Fat  and  Blood.     An   Essay  on  the  Treatment  of  certain 
forms  of  Neurasthenia  and  Hysteria. "    Fifth  edition  (1888). 

£  E  2 


468  Food  in  Disease.  [Partii. 

utilised  thi'ough  the  influence  of  massage  "  kneading 
the  muscles,  and  by  moving  them  with  currents  able 
to  effect  this  end."  To  insure  the  most  absolute  rest 
in  cases  of  great  weakness,  -the  patient  is  fed  by  a 
nurse ;  and  when  well  enougli  to  sit  up  in  bed,  the 
meats  arc  cut  up,  so  as  to  make  it  easier  for  the 
patient  to  feed  herself. 

The  treatment  is  begun  by  putting  the  patient  on 
milk  diet — three  or  four  ounces  every  two  hours, 
increased  in  a  few  days  to  two  quarts,  given  in 
divided  doses  every  thi-ee  hours.  Tliis,  says  Dr. 
Weir  Mitchell,  "nearly  always  dismisses,  as  by 
magic,  all  the  dysj)eptic  conditions."  The  bowels 
are  regulated  by  giving  a  ou[)  of  coffee,  Avithout  sugar, 
on  waking,  or  a  grain  of  watery  extract  of  aloes  at  bed- 
time ;  or,  in  more  obstinate  cases,  a  quarter  of  a  grain 
of  watery  extract  of  aloes  and  two  grains  of  dried  ox- 
gall thrice  a  day. 

After  four  to  seven  days  a  light  breakfast  is  per- 
mitted ;  a  day  or  two  later,  a  mutton  chop  as  a  mid- 
day dinner  ;  and  again,  in  a  day  or  two,  bread  and 
butter  thrice  a  day.  After  ten  days,  usually,  the 
patient  is  allowed  three  full  meals  daily,  as  well  as 
three  or  four  pints  of  milk,  given  at  or  after  meals, 
in  place  of  water,  and  two  to  four  ounces  of  fluid 
jNIalt  Extract  before  each  meal. 

"  No  trouLlesome  symjDtoms  usually  result  from  this  full 
feeding,  and  the  patient  may  be  made  to  eat  more  largely  by 
being  fed  by  her  attendant.  1  like  to  give  butter  largely,  and 
have  little  trouble  in  getting  this  most  wholesome  of  fats  taken 
in  large  amounts.  A  cup  of  cocoa  or  of  coffee  with  milk  on 
waking  in  the  morning  is  a  good  preparation  for  the  fatigue  of 
the  toilet.  At  the  close  of  the  first  week  1  like  to  add  1  lb.  of 
beef,  in  the  form  of  raw  soup.  This  is  made  by  chopping  up 
1  lb.  of  raw  beef,  and  placing  it  in  a  bottle  with  one  pint  of 
water  and  five  drops  of  strong  hydrochloric  acid.  This  mixture 
stands  in  ice  all  night,  and  in  the  morning  the  bottle  is  .set  in  a 
pan  of  water  at  110°  Fahr.,  and  kept  two  hoars  at  about  this 
temperature.  It  is  then  thrown  on  to  a  stoat  cloth,  and 
strained  until  the  mass  which  remains  is  nearly  dry.  The 
filtrate  is  given  in  three  portions  daily.  If  the  raw  taste  prove 
very  objectionable,  the  beef  to  be  used  is  quickly  roasted  on 


Chap.  VII.]        Diet  in  Neurasthenia.  469 

one  side,  and  then  the  process  is  completed  in  the  manner  above 
described.  The  soup  thus  made  is  for  the  most  part  raw,  but 
has  also  the  flavour  of  cooked  meat. 

"  In  difficult  cases  I  sometimes  add,  at  the  third  week,  \  oz. 
of  cod-liver  oil,  half  an  hour  after  each  meal.  If  it  lessens 
appetite,  or  causes  nausea,  I  emploj'^  it  thrice  a  day  as  a  rectal 
injection,  and  in  cases  where  the  large  doses  of  iron  used  cause 
intensi  constipation,  I  find  the  use  of  cod-liver  oil  enemata 
doubly  valuable,  by  acting  as  a  nutriment,  and  by  disposing 
the  bowels  to  act  daily.  When  given  thus,  I  like  to  use  it  in 
an  emulsion  made  with  the  jui'.e  drained  off,  after  crushing  the 
fresh  pancreas  of  the  beef  in  warm  water.  Enough  of  water 
to  cover  \  lb.  of  chopped  pancreas  is  allowed  to  stand  for  an 
hour  in  a  warni  kitchen,  and  then  squnezed  through  a  towel. 
An  ounce  is  mixed  with  half  that  amount  of  oil  and  injected 
slowly  thiice  a  day."     ( Weir  Mitchell.) 

As  to  stimulants,  when  there  is  no  question  of 
breaking  off  the  alcoholic  habit,  a  small  amount  of 
stimulant  has  been  found  to  assist  in  the  lapid  in- 
crease of  fat ;  such  as  an  ounce  of  whisky  daily  in 
milk,  or  a  glass  of  diy  champagne,  or  Burgundy, 
or  other  red  wine.  It  increases  the  capacity  to  take 
food  at  meals.     Alcohol,  however,  is  not  essential. 

With  the  administration  of  solid  food,  iron  is 
given  in  large  doses;  and  when  the  patient  is  able  to 
sit  up,  "  rather  full  doses  of  sulphate  of  strychnia 
thrice  a  day,  with  iron  and  arsenic." 

As  to  the  consumption  of  this  "  vast  amount  of 
food,"  Dr.  Weir  Mitchell  observes  : — "  I  have  watched 
again  and  again,  with  growing  surprise,  some  listless, 
feeble,  white-blooded  creature  learning  by  degrees  to 
consume  these  large  rations,  and  gathering  under 
their  use  flesh,  colour,  and  wholesomeness  of  mind 
and  body," 

When  the  patient  is  taking  the  full  diet,  it  is 
neces.sary  to  watch  the  urine.  When  urates  begin 
to  be  deposited,  it  must  be  regarded  as  a  sign  of 
over-feeding,  and  some  redaction  in  the  quantity  of 
food  must  be  made.  Attacks  of  dyspepsia  (which  are 
apt  to  occur)  or  diarrhoea  are  met  by  reducing  the 
diet  one-half,  or  returning  to  a  milk  diet  for  a  day 
or  two. 


47 o  Food  in  Disease.  [Partii. 

Two  or  three  detailed  examples  of  the  diet  em- 
ployed in  the  treatment  of  these  cases  will  be  the 
best  conclusion  to  this  chapter. 

Case  1. — (Weir  Mitchell.) 

Mrs.   C,  kept  in  bed,  fed  by  ar.   attendant,  rose  only  to 

relieve  bladder  and  rectum. 

1st  day. — One  quart  of  milk,  in  divided  doses,  every  2  hours. 

2nd  day. — Cup  of  coffee  on  waking.  Two  quarts  of  milk,  in 
divided  portions,  every  2  hours.     Aloetic  pill  at  night. 

3rd  to  6th  days. — Same  diet. 

7th,  8th,  and  9th  days. — Same  diet,  with  a  pint  of  raw  soup,  in 
three  portions. 

10th  day.— 7  a.m.,  coffee.  7.30  a.m.,  ^  pint  milk.  10  a.m., 
ditto.  12  noon,  2,  4,  6,  8,  and  10  p.m.,  ditto.  Soup  at 
11  a.m.,  5  and  9  p.m. 

14  th  day. — Egg  and  bread  and  butter  added. 

16th  day. — Dinner  added,  and  iron. 

19th  day. — The  entire  diet  was  as  follows : — 7  a.m.,  coffee. 
8  a.m.,  iron  and  malt  extract;  breakfast,  consisting  of  a 
chop,  bread  and  butter,  a  tumbler  and  half  of  milk. 
11  a.m.,  soup.  2  p.m.,  iron  and  malt ;  dinner  of  anything 
she  liked,  with  6  oz.  of  Burgundy  or  drj'  champagne,  and 
at  the  end  one  or  two  tumblers  of  milk.  4  p.m.,  soup. 
7  p.m.,  malt,  iron,  bread  and  butter,  usually  some  fruit, 
and  commonly  2  glasses  of  milk.  9  p.m.,  soup.  10  p.m., 
aloetic  pill. 

(At  12  noon,  massage  for  an  hour.  At  4.30  p.m.,  electricity 
applied  for  an  hour.) 

At  %th  week,  soup  and  wine  were  dropped,  iron  lessened  one 
half,  massage  and  electricity  only  on  alternate  days.  3*oth 
of  a  grain  of  sulphate  of  strychnia  thrice  a  day  at  meals 
(continued  for  several  months). 

At  9th  week,  milk  reduced  to  a  quart.  All  mechanical  treat- 
ment ceased. 

Result. — Gain  in  flesh  about  face  in  2nd  week.  Weight 
rose  in  two  months  from  96  to  136  lb. ;  gain  in  colour  equally 
marked.  At  30th  day  patient  had  normal  catamenial  flow,  after 
5  years  of  faihire  to  menstruate.  At  9th  week,  drove  out 
Cure  complete  and  permanent. 

Case  2. — (Dr.  Plavf-air.) 

A.  B.,  age  32.     Rest  in  bed,  isolation. 

Ist  day. — 22  oz.  of  milk,  in  divided  doses. 
2nd  day.— 50  oz.  of  milk,  in  divided  doses. 
3rd  day. — 50  oz.  of  milk,  in  divided  doses.     (Massage,  J  an 
hour.) 


Chap. VII.]       Neurasthenia  Dietaries,  471 

4th  day. — 50  oz.  of  milk,  in  divided  doses  ;  &%%  and  bread  and 
butter ;  dialysed  iron,  40  minims,  in  2  doses.  (Massage, 
\\  hour.) 

6th  day. — 50  oz.  of  milk,  in  divided  doses ;  mutton  chop. 
(Massage,  1  hour  50  minutes.) 

8th  day. — 50  oz.  of  milk,  in  divided  doses  ;  mutton  chop ;  por- 
ridge, and  a  gill  of  cream ;  maltine  twice  daily. 
(Massage,  3  hours;  electricity,  \  an  hour  •,  continued  to  end 
of  treatment. ) 

16th  day. — Three  full  meals  daily  of  fish,  meat,  vegetables, 
cream,  and  fruit;  2  quarts  of  milk  and  2  glasses  of 
Burgundy, 

22nd  day. — Amount  of  food  lessened. 

Remit. — On  22nd  day  sat  in  a  chair  for  an  hour,  after  a 
month  walked  downstairs  and  went  out  for  a  drive.  "Enor- 
mous increase  in  size."     Cure  complete  and  permanent. 

Ca8e  3. — (Dr.  Playfair.) 
Dietary  on  IQth  day. 

6  a.m. — Raw  meat  soup,  10  oz. 

7  a.m. — Cup  of  black  coffee. 

8  a.m. — Plate  of  oatmeal  pon-idge,  gill  of  cream,  a  boiled  egg, 

3  slices  of  bread  and  butter,  and  cocoa. 
11  a.m.— Milk,  10  oz. 
2  p.m. — Rump-steak,  ^  lb.  potatoes,   cauliflower,  a  savoury 

omelette;  milk,  10  oz. 
4  p.m. — Milk,  10  oz.,  3  slices  of  bread  and  butter. 
6  p.m. — Cup  of  gravy  soup. 
8  pm. — A  fried  sole,  roast  mutton  (3  large  slices),  French 

beans,  potatoes,  stewed  fruit  and  cream ;  milk,  10  oz. 
11  p.m. — Raw  meat  soup,  10  oz. 

Same  scale  of  diet  continued  through  whole  treatment. 
Consumed  with  relish  and  appetite.     No  dyspeptic  symptoms. 

Result.  — (^fi\n  in  weight  in  six  weeks  from  4  st.  7  lb. 
to  7  St.  8  lb.  =  3  St.  1  lb. 

Case  4. — (Dr.  John  Keatino.) 

P.  D.,   a   wale,  age   53    (loss   of   nervous   muscular  force, 
defective  memory,  insomnin,  convulsive  muscular  twitching^, 
frequent  cough,  emaciation,  slight  night  sweats,  impaired  re- 
sonance right  apex). 
Treatment. — Allowed  to   be  out  of  bed   once  a  day  for  four 

hours,  one  of  which  was  spent  in  business. 
Food. — G  a.m. — .\  tumbler  of  strong,  hot  beef-tea,  made  from 

Australian  extract. 
8  a.m, — Half-tumbler  of  iron-water,  and  breakfast  of  fruit 

steak,  Dotatoe.^,  coffee,  and  a  goblet  of  milk. 


472  Food  in  Disease.  [Panii. 

8.30   a.m. — A    goblet    of    milk,   with    a    dessertspoonful    of 

LoetUmd's  Malt  Extract,  6  grains  of  citrate  of  iron  and 

quinine. 
10  a.m. — Electricity. 
12  noon — Goblet  of  milk  and  malt, 
2  p.m. — Dinner  (preceded  by  half-tumbler  of  iron -water  and  a 

third  goblet  of  milk  and  malt). 
6   p.m. — Third   dose  of  iron -water.     Light  supper  of   fruits, 

bread  and  buttor,  and  cream  ;  a  fourth  goblet  of  milk  and 

malt. 
10  p.m. — Beef  soup,  4  oz.,  preceded  by  massage  with  cocoa  oil 

for  an  hour. 
Two  quarts  of  milk  were  taken  daily,  in  addition  to  all  other  food. 

Result. — A  gain  of  over  lo  lb.  in  weight,  cough  gone, 
became  and  remained  strong  and  well. 

This  method,  as  adopted  by  Ley  den,  is  thus 
described  by  Germain  S^e  : — 

At  7  a.m. — Half  a  litre  of  milk,  slowly  sipped  in  ^  an  hour,  a 

small  cup  of  coffee  with  cream,  80  grammes  (nearly  3  oz. ) 

of  cold  meat,  a  plate  of  fried  potatoes. 
10  a.m.  —  A  litre  of  milk,  with  3  biscuits. 
12  noon. — The  same. 
1  p.m. — Broth,  200  grammes  (about  7  oz.)  of  tow\,  puree  of 

potatoes,  green  vegetables,  120  grammes  (about  4  oz.)  of 

compote  and  pastry. 
3.30,  5.30,  8,  and  9.30  p.m.— Half  a  litre  of  milk,  making  a 

diily  consumption  of  3|  litres  of  milk. 
In  the  after  part  of  the  day,  two  metis  each  of  80  grammes 

(3  oz.)  of  roast  meat,  with  bread  and  3  biscuits. 

The  class  oi  fat  anfemic  people — mostly  women — 
are  alluded  to  by  Dr.  Weir  Mitchell  as  of  the 
"utmost  clinical  interest."  They  are  rare,  as  he 
remarks,  and  must  be  dependent  on  conditions  not 
common  to  all  ana?mics.  The  cases  that  we  have  seen 
have  been  apparently  traceable  to  long  continued 
faults  of  diet,  especially  to  the  avoidance  of  nitro- 
genous food  and  the  consumption  of  a  vastly-increased 
proportion  of  carbohydrates. 

One  of  the  most  remarkable  cases  of  this  kind  we 
ever  observed  was  in  a  patient  who  had  a  perfect 
mania  for  pastrycooks'  sweets.  8he  spent  large  sums 
of  money  habitually  at  the  pastrycook's  ;  and  when 
any  impediment  was  put  in  her  way,  she  would 
succeed,  by   all   sorts   of  ingenious  contrivances,  in 


Chap,  VII.]       Neurasthenia  Dietaries.  473 

getting  her  usual  supply  of  sweets,  This  enormous 
consumption  of  carbohydrates  in  combination  with 
fat  (as  in  pastry)  was,  of  course,  associated  with 
entire  indifference  to  animal  food. 

"  Obesity  with  thin  blood  "  is  certainly,  as  Dr. 
Weir  Mitchell  maintains,  a  "  most  unmanageable 
condition."  The  most  useful  treatment  he  believes 
to  be  a  combination  of  an  exclusively  milk  diet — 
well-skimmed  milk — with  rest  and  massage. 

"  In  old  cases  of  this  kind,  the  best  plan  is  to  put 
the  patient  at  rest,  to  use  massage,  restrict  the  diet  to 
skimmed  milk,  or  to  milk  and  broth  free  from  fat, 
and  with  them,  when  the  weight  has  been  sufficiently 
lowered,  to  give  iron  freely,  and,  by  degrees,  a  good 
general  diet,  under  which  the  globules  rise  in  number, 
BO  that  even  with  a  new  gain  in  flesh  there  comes  an 
equal  gain  in  strength  and  comfort." 

He  gives  as  an  example  the  case  of  a  lady,  aged 
forty-five,  who  weighed  190  lb.,  her  height  being  5  ft. 
4|^  in.  ;  she  was  also  anaemic,  feeble,  and  breathless. 

"  She  was  kept  in  bed  five  weeks.  Massage  was  used  at 
first  once  daily,  and  after  a  fortnight  twice  a  day,  while  mil'v 
was  given,  and  in  a  week  made  the  exclusive  diet.  Her  average 
of  loss  for  30  days  was  a  pound  a  day,  and  the  diet  was  varied 
hy  the  addition  of  hroth  after  the  third  week,  so  as  to  keep  the 
reduction  within  safe  limits.  .  .  .  After  two  weeks  I  gave  her 
the  lactate  of  iron  every  three  hours  in  full  doses.  Tn  the 
4lh  week  additions  were  made  to  her  diet-list,  and  Swedish 
movements  were  added  to  massage,  which  w.is  applied  hut  once 
a  day  ;  and  during  the  Sth  week  she  began  to  sit  up  and  move 
about.  Her  weight  at  the  7th  week  liad  fallen  to  145  lbs.,  and 
her  appearance  had  decidedly  improved.  .  .  .  Now,  after  two 
years,  she  is  a  well  and  vigorous  woman." 

In  all  these  cases  the  milk  should  be  well  skimmed, 
and  slowly  taken  in  small  mouthfuls  at  a  time.  It 
may,  Avhen  necessary,  be  flavoured  with  a  little  tea  or 
coffee,  or  caramel  or  salt.  Its  digestion  is  often  aided 
by  scalding  with  one-fourth  the  quantity  of  boiling 
water ;  and  a  few  grains  of  bicarbonate  of  soda  or  a 
little  alkaline  water  (Vichy,  Vals,  ApoUinaris)  may 
be  added. 


474 


CHAPTER    VI TI. 

FOOD  IN  RICKETS,  SCURVY,  SCROFULA,  CONSUMPTION, 
AND  CHRONIC  FEBRILE  CONDITIONS  —  FORCED 
FEEDING    (sURALIMENTATION). 

Rickets  is  a  malady  arising  in  infancy  from  mal- 
nutrition, and  its  remedy  is  mainly  dietetic. 

In  some  instances  it  is  believed  to  originate  in 
intra-uterine  life  from  the  inferior  nutrition  of  the 
mother,  and  as  a  prophylactic  measure,  attention  to 
the  diet  and  nutrition  of  a  mother  who  has  previously 
borne  children  that  have  become  rickety  is  certainly 
advisable. 

It  has  been  experimentally  shown  that  rickets 
can  be  produced  in  young  animals  by  depriving  them 
of  animal  fats  and  earthy  salts — especially  of  calcium 
phosphates — and  in  looking  to  the  feeding  of  a 
pregnant  woman,  care  should  be  taken  that  an 
adequate  amount  of  fat  and  of  lime  salts  enters  into 
its  composition.  The  same  considerations  apply  to 
the  diet  of  the  mother  who  is  suckling  her  own  infant, 
or  to  the  wet-nurse.  Much  that  has  been  said  in  the 
chapter  on  Infant  Feeding  is  of  importance  in  con- 
nection with  the  dietetic  treatment  of  infantile 
rachitis. 

The  common  error  upon  which  the  productioii  of 
rickets  often  depends  is  the  too  great  reliance  by  the 
poorer  classes  on  farinaceous  foods.  Infants  fed 
almost  entirely  on  farinaceous  foods  are  pretty 
certain  to  become  the  subjects  of  rachitis. 

In  order  to  avoid  this  in  the  case  of  hand-fed 
infants,  it  is  of  the  first  importance  to  introduce  the 
full  quantity  of  fats  and  proteids  into  their  diet  as 
calculated  from  the  composition  of  healthy  mother's 
milk,  and  as  fully  explained  in  the  chapter  on  Infant 


Chap.  VIII.)  Diet  IN  Rickets.  475 

Feeding.  The  milk  must  contain  a  full  proportion  of 
cream,  and  this  may,  in  most  cases,  be  added  in 
excess  with  advantage ;  the  addition  also  of  cod-liver 
oil  to  the  dietary  is  decidedly  valuable — this  may  be 
made  into  an  emulsion  by  shaking  up  with  lime-water 
and  some  syrup  if  the  child  objects  to  it  in  the  pure 
state.  Raw  meat  juice  is  an  excellent  addition  to 
the  food  of  such  children,  as  it  is  rich  in  salts,  and  a 
little  phosphate  of  lime  may  usefully  be  added  to 
some  of  the  milk  taken.  If  skimmed  milk  is  used 
for  feeding  infants  it  may  actually  tend  to  the 
development  of  rickets  from  its  not  containing  the 
necessary  amount  of  fat. 

Baw  meat  pulp  has  been  given  with  great  advan- 
tage to  rickety  children,  to  the  extent  of  2  oz. 
daily,  according  to  the  age  of  the  child.  The  milk 
supplied  to  such  children  should  be  abundant  (so 
long  as  it  is  well  digested),  and,  as  we  have  already 
said,  it  should  be  of  good  quality.  For  the  older 
children,  milk  puddings  made  with  "  entire  wheat 
flour"  are  suitable. 

It  sometimes  happens  amongst  the  poor  that 
prolonged  suckling  (for  economical  motives)  leads  to 
the  development  of  rickets ;  under  such  circumstances 
immediate  weaning  of  the  child  and  the  substitution 
of  an  adequate  nourishing  dietary  on  the  principles 
already  laid  down  are  of  the  first  importance.  Farina- 
ceous foods  alone  are  unsuitable  for  the  nourishment 
of  such  children,  because  they  are  not  only  poor  in 
lime  salts,  but  they  readily  undergo  lactic  acid 
fermentation,  and  this  has  been  shown  to  aggravate 
the  rachitic  state.  When  the  child  is  older,  sand- 
wiches of  raw  meat  pulp,  meat  juices  and  broths,  eggs 
beaten  up  with  milk  or  lightly  boiled,  the  juice  of 
fresh  fruits,  or  fruit  jellies,  may  be  added  to  the 
dietary  from  time  to  time. 

Meat  juice  is  very  valuable  in  anaemic  cases ;  an 
easy  mode  of  preparing  it  is  to  take  a  piece  of  good 
lean  beef,  rapidly  brown  the  outside  over  a  quick  fire 
and   express   the  juice   with   a   lemon-squeezer ;   or 


476  Food  in  Disease.  [Partii. 

Valentin's  meat  juice,  well  diluted,  may  be  used 
instead. 

Scurvy  is  another  disease  which  is  caused  by 
defective  nutrition,  and  is  dependent  on  the  absence 
of  certain  necessary  constituents  of  food. 

It  has  been  found  to  occur  amongst  persons  such 
as  sailors,  prisoners,  and  soldiers  on  active  service, 
who  have  been  deprived  of  fresh  meat  and  vegetables 
and  fed  on  a  monotonous  diet — such^  for  example,  as 
salt  meat  and  biscuit. 

Prophylactic  and  curative  measures  consist  in  the 
maintenance  of  a  due  supply  of  fresh  animal  food 
and  especially  of  fresh  vegetables.  In  the  navy  and 
the  mercantile  marine,  lemon  or  lime  Juice  served 
out  daily  in  certain  quantity  is  found  to  serve  as  a 
prophylactic  against  outbreaks  of  this  disease.  It  has 
been  stated  by  Garrod  that  the  occurrence  of  scurvy 
is  due  to  the  absence  of  potash  salts  in  the  food,  and 
that  the  remedial  value  of  fresh  meat,  fresh  milk, 
fresh  vegetables,  and  of  fruit  juices,  depends  on  their 
supplying  the  potash  salts  necessary  for  healthy 
nutrition. 

Infants  fed  exclusively  on  what  are  termed 
"  proprietary  foods  "  have  been  observed  to  become 
scorbutic.  Cheadle  remarks  that  he  has  found  scurvy 
in  children  brought  up  on  peptonised  milk  and  on 
patent  pancreatised  farinaceous  foods.  "  Clearly  the 
process  of  peptonising  or  pan  creating  in  some  way 
impairs  the  virtue  of  the  anti-scorbutic  element  in 
milk." 

To  the  diet  of  such  children  should  be  added,  as 
anti-scorbutics,  potato-pulp,  fresh  milk,  and  raw  meat 
juice. 

The  following  is  a  method  for  making  fine  potato 
gniel  for  this  purpose : — Rub  steamed  flowery 
potatoes  through  a  fine  sieve,  beat  this  up  well  with 
milk  till  smooth  and  of  the  consistence  of  thin  cream. 
A  teaspoonful  of  this  may  be  added  to  each  bottle 
of  food,  at  first,  and  gradually  increased  to  a  dessert- 
spoonfuL 


Chap.  VIII.)  Diet  in  Scuruy.  477 

Well-boiled  carrots  may  be  used  in  the  same  way. 
Broths  in  which  such  vegetables  as  carrots  and 
potatoes  have  been  boiled  and  strained  out  are  also 
useful.  The  juice  of  oranges  and  other  fresh  fruits 
is  also  of  much  service. 

In  all  these  fresh  foods  their  anti-scorbutic  in- 
fluence is  believed  to  be  due  to  the  presence  of 
potash  in  combination  chiefly  with  organic  acids  such 
as  citric,  malic,  aud  tartaric  acid. 

When  fresh  vegetables  cannot  be  obtained,  a 
certain  amount  of  lime  juice  or  lemon  juice  may  be 
taken  instead.  In  certain  forms  of  the  disease,  when 
there  is  persistent  haemorrhage,  it  has  been  main- 
tained that  neutral  citrates  and  tartrates  act  better 
than  fresh  lemon  juice — the  latter  seeming  to  favour 
the  oozing  of  blood.* 

The  state  of  the  mouth  in  some  of  these  cases 
must  be  taken  into  consideration  in  determining  a 
suitable  dietary.  When  there  is  stomatitis  and  the 
gums  ai'e  tender,  swollen,  and  bleeding,  we  must  give 
soft,  uuirritating  food  that  does  not  need  mastication 
— such  as  fresh  milk,  eggs,  meat  broths  and  soups, 
pui'ees  of  fresh  vegetables,  together  with  orange  or 
lemon  juice.  For  patients  who  are  able  to  masticate, 
a  choice  amongst  any  of  the  following  foods  may  be 
permitted,  as  they  all  possess  anti-scorbutic  properties: 
fresh  meat,  potatoes,  fresh  green  vegetables  of  all 
kinds,  pickles,  as  well  as  the  foods  already  referred  to. 

The  close  pathological  relationship,  if  not  identity, 
between  scrofula  and  consumption  makes  it  ap- 
l)ropriate  to  discuss  their  dietetic  management 
together. 

Consumption  is  also  the  type  of  chronic  febrile 
disorders,  and  the  progressive  emaciation,  which  is  its 
characteristic  feature,  and  from  which  it  derives  its 
name,  is  chiefly  dependent  on  the  presence  in  the 
great  majority,  or,  at  some  time  or  other,  in  all 
cases,  of  more  or  less  fever.     It  is  the  progressive 

♦  Wright :  Brilush  Mtdical  Jownal,  vol.  ii.,  1804,  p.  37. 


478  Food  in  Disease.  [Partii. 

destruction  or  consumption  of  the  tissues  caused  by  this 
chronic  fever  that  we  are  called  upon  to  antagonise 
or  compensate  for  by  appropriate  food.  And  the 
dietetic  measures  which  are  expedient  and  useful  to 
check  the  wasting  of  consumptives  are  applicable  also 
to  other  cases  in  which  a  chronic  pyrexial  state  is 
present. 

When  a  child  shows  the  well-knowii  signs  of  a 
scrofulous  constitution,  or  when  he  is  known  to  in- 
herit a  tendency  thereto,  it  becomes  a  matter  of  great 
importance  that  he  should  be  well  and  carefully  fed. 
It  is  not,  however,  necessary  to  repeat  here  what  has 
already  been  said  in  the  chapter  on  Food  in  Infancy 
and  Childhood :  the  principles  of  wholesome  feeding 
during  this  period  and  the  means  of  carrying  them 
out  have  been  there  fully  dwelt  on.  There  can  be  no 
doubt  that  an  insufficient  or  inappropriate  diet  in  the 
early  years  of  life  predisposes  to  the  development  of 
scrofula,  not  only  in  those  who  have  a  hereditary 
tendency  thereto,  but  in  others  also.  A  poor,  coarse, 
innutritious  vegetable  dietary,  involving  much  diges- 
tive effort  for  its  assimilation,  and  often  causing 
irritation  of  the  organs  of  digestion,  and  yielding 
little  nourishment  in  proportion  to  its  bulk,  is,  no 
doubt,  provocative  of  many  of  the  manifestations  of 
scrofula  observed  amongst  the  children  of  the  poorer 
classes ;  while,  on  the  other  hand,  a  sound  and 
}ational  diet  in  infancy  and  early  life  acts  as  a  most 
efficient  prophylactic  against  the  development  of  this 
disease. 

We  should  be  careful  in  all  such  cases  to  avoid 
the  administration  of  food  calculated  to  set  up  irri- 
tation of  the  child's  digestive  organs ;  or,  if  such 
already  exists,  we  should  at  once  supply  a  bland, 
unirritatiug  diet  calculated  to  remove  it. 

In  poor  families  it  is  often  the  custom  to  allow 
quite  young  children  to  partake  of  the  same  coarse 
food  as  the  grown-up  members  of  the  family.  Tliis  is 
a  most  pernicious  custom,  and  often  proves  highly 
injurious  even   to  the   most  robust  children.     How 


Chap.  VIII.]  Diet  IN  Scrofula.  479 

much  more  so  must  it,  therefore,  be  to  the  delicate 
and  scrofulous] 

Such  children  should  have  an  abundant  supply  of 
good  milk  as  the  basis  of  their  diet,  also  sound  whole- 
meal bread  and  plenty  of  butter.  Easily-absorbable 
fats  are  especially  valuable  to  the  scrofulous.  Cod- 
liver  oil  is  one  of  the  best,  and  it  has  the  advantage, 
if  regularly  given,  that  it  tends  to  overcome  the 
constipation  so  common  in  scrofulous  children; 
but  many  other  forms  of  fat  are  extremely  useful, 
such  as  butter,  cream,  bacon  fat,  dripping.  Bread 
lightly  toasted  and  soaked  in  fluid  bacon  fat  or 
dripping  is  generally  liked  by  children,  and  is  most 
wholesome.  Suet  puddings,  served  with  treacle, 
sugar,  or  jam,  are  also  generally  popular  witli 
children,  and  may  be  made  the  means  of  introducing 
a  considerable  amount  of  fat  in  the  food,  whicli 
"would  be  rejected  if  presented  in  its  natural  form. 
Mutton  suet,  chopped  fine  and  boiled  in  milk  and 
sweetened,  is  another  useful  expedient  of  the  same 
kind. 

It  is  always  necessary  to  pay  much  attention  to 
the  digestion,  and  at  once  to  modify  the  diet  if  it  is 
found  to  be  attended  with  signs  of  dyspepsia. 

In  scrofulous  children  of  the  fat  and  flabby  type 
it  is  not  so  important  to  administer  fatty  food.s.  It 
is  better  in  such  cases  to  give  a  diet  ricli  in  albumi- 
nates, but  small  in  bulk. 

The  common  eiTor  is  to  keep  such  children  too 
exclusively  on  farinaceous  foods,  and  to  give  them  a 
very  insutiicient  supply  of  animal  food.  In  children 
with  very  delicate  digestions  it  is  often  difficult  to 
get  them  to  take  fats  or  oils  of  any  kind.  In  such 
cases  inunction  with  oil — cod-liver  oil  or  olive  oil — 
after  washing  the  surface  with  hot  water  and  soap,  is 
a  good  plan.  All  these  cases  require  also  an  abund- 
ance of  respiratory  food,  an  abundance  of  active 
oxygen,  which  they  should  be  allowed  to  obtain 
by  a  life  in  the  open  air — in  the  countiy  or  by 
the  sea. 


480  Food  in  Disease.  [Partii. 

In  cases  of  a  disease  like  pulmonary  coiisuinp- 

tion,  attended  witli  a  chronic  febiile  condition,  and 
consequent  continuous  loss  of  weight,  unless  this 
progressive  wasting  is  counterbalanced  by  the  supply 
and  annexation  of  an  adequate  amount  of  food,  the 
patient  must,  in  course  of  time,  succumb  to  the 
disease.  But  not  only  is  it  necessary  in  such  cases 
to  arrest  the  loss  of  weight,  we  must  also  strive  f  o 
to  improve  the  nutrition  that  the  body  may  gain  in 
weight ;  for  it  is  well  known  that  if  we  are  able  to 
establish  an  improved  state  of  nutrition,  the  disease 
itself  becomes  favourably  influenced  thereby.  Our 
success  in  this  effort  will  depend  much  on  the  amount 
and  type  of  the  febrile  state  which  accompanies  the 
malady.  When  there  are  distinct  intermissions  or 
remissions  in  the  febrile  movement,  and  when  this  is 
quite  moderate,  we  may  succeed  in  procuring  the 
assimilation  of  a  considerable  quantity  of  food,  pro- 
vided great  care  and  discretion  be  employed  in  its 
selection  and  preparation.  But  when  the  fever  is 
considerable  and  i)ersistent,  and  the  digestive  func- 
tions (as  is  usually  the  case  under  such  circum- 
stances) are  greatly  impaired  and  aj)])etite  is  entirely 
absent,  it  may  be  difficult  or  even  impossible  to 
obtain  the  appropriation  of  a  sufficient  quantity  of 
food  to  exercise  any  adequate  check  on  the  wasting 
process.  In  such  cases  we  are  compelled  to  have 
recourse  wholly  to  fluid  and  easily-absorbable  foods 
in  much  the  same  manner  as  in  the  dietetic  manage- 
ment of  acute  febrile  diseases. 

It  is  a  generally-accepted  rule  that,  in  the  diet 
of  the  consumptive,  fats  and  carbohydrates — i.e.  the 
especially  fattening  forms  of  food — should  be  at  any 
rate  adequately,  if  not  superabundantly,  represented. 
A  proper  proportion  also  of  albuminates  must  be 
included  in  their  dietary. 

One  of  the  greatest  difficulties  we  encounter  in 
providing  a  suitable  and  adequate  diet  for  consump- 
tives is  the  frequency  with  which  they  complain  of 
digestive  troubles,  want  of  appetite,  and  occasionally 


Chap.  VIII.]         Diet  in  Consumption.  481 

of  positive  disgust  for  food.  Under  such  circumstances 
it  is  most  important  to  provide  well-cooked,  appetising, 
and  attractively- served  food,  varied  as  much  as 
possible,  and,  so  far  as  is  consistent  with  whole- 
someness,  agreeable  to  the  tastes  of  the  patient.  In 
the  distinctly  febrile  forms  it  will  be  advisable  to 
give  small  quantities  of  nutritious  food  at  short 
intervals. 

Some  suggestive  observations  as  to  food  in  Dr. 
H.  Weber's  lectures  on  the  "  Hygienic  Treatment  of 
Phthisis  "  may  be  here  quoted.  He  directs  attention 
to  "  the  possibility  that  there  may  be  important  rela- 
tions between  the  life  of  the  tubercle  bacillus  and  the 
quantity  of  the  food  that  we  take,  especially  the  saline 
materials  which  enter   into  the    composition  of   the 

blood,   the   cells,   and   tissues Microbes 

require  mineral  food  in  the  same  way  as  plants  and 
animals  do ;  and  if  we  knew  exactly  which  mineral 
substances  the  tubercle  bacillus  requires,  and  could 
without  harm  to  ourselves  deprive  our  blood,  and 
cells,  and  tissues  of  these  salts,  by  abstaining  from  food 
containing  them,  we  should  deprive  the  bacillus  of 
the  means  of  existence."  *  The  difficulties  attending 
such  an  investigation  are,  of  course,  very  great.  A 
hint  in  the  right  direction  may  possibly  be  gained 
from  the  fact  "  that  the  food  of  carnivorous  animals 
I  contains  a  larger  quantity  of  soda  and  smaller  of 
^  potash  than  that  of  herbivorous  animals,  and  carni- 
vorous animals  are  on  the  whole  less  subject  to  tuber- 
culosis than  herbivorous  animals.  If  it  could  be 
proved  that  the  potash  salts  are  more  conducive  to 
the  growth  of  tubercle  bacillus  than  soda  salts, 
articles  of  food  containing  excessive  proportions  of 
potash  ought  to  be  taken  only  sparingly."  G.  Sde 
also  suggests  that  the  use  of  cod-liver  oil  may  produce 
a  condition  of  the  tissues  hostile  to  the  propagation  of 
the  tubercle  bacillus ;  this  may  be  due,  he  thinks,  to 
the  oil  appropriating  some  of  the  oxygen  required  for 
the  active  multiplication  of  the  microorganism. 
♦  "Croonian  Lectures,"  p.  47. 


482  Food  in  Disease,  [Pan  11. 

"  The  oil  then  aclis  as  a  protective  agent  to  our 
organism,  it  acts  as  a  destructive  agent  to  the  micro- 
organisms ;  our  waste  is  lessened,  which  is  useful ; 
the  nutrition  of  the  baoilhis  is  interfered  with,  which 
is  still  more  useful."  * 

Phthisical  patients,  whose  digestive  functions  are 
unimpaired,  may  be  allowed  to  partake  of  the  various 
nourishing  forms  of  food  that  enter  into  the  ordinary 
dietary  of  the  healthy,  in  addition  to  which  two  or 
three  glasses  of  milk  should  be  taken  at  convenient 
intervals  between  meals,  and  one  of  these  glasses 
of  milk  should  be  taken  the  last  thing  at  night,  or 
even  ])referably  during  the  night  if  the  patient  is 
awake. 

Milk  is  a  most  valuable  food  for  the  consumptive, 
and  we  have  already  mentioned  the  several  expedients 
which  may  be  adopted  for  promoting  its  digestibility 
when  it  is  not  well  borne. 

By  adding  to  each  glass  of  milk  two  tablespoonfuls 
of  hot  water  in  which  about  six  grains  of  bicarbonate 
of  soda  and  five  grains  of  common  salt  are  dissolved, 
we  can  often  remove  the  difficulty  in  the  digestion  of 
\^  milk,  particularly  when  the  milk  is  very  lich.  When 
we  find  evidence  that  the  patient  really  cannot  digest 
the  casein  of  milk — i.e.  when  we  find  hard  curds  of 
milk  rejected  by  vomiting,  or  giving  rise  to  intestinal 
troubles  and  forming  the  chief  part  of  bulky  white 
motions — then  we  should  make  use  of  whey  as  a 
beverage.  Its  mode  of  preparation  has  already  been 
described.  A  little  cream  may  be  added  to  it  if  desired. 

Cream  may  also  be  made  more  digestible  and 
more  acceptable  to  many  patients  by  mixing  it  with 
an  equal  quantity  of  hot  water,  and  adding  to  each 
teacupful  of  the  mixture  a  teaspoonf ul  of  the  aromatic 
spirits  of  ammonia ;  some  prefer  a  teaspoonful  of 
l)randy.  In  other  cases  we  may  use  peptonised  milk, 
and  1  have  found  patients  able  to  digest  Savory  and 
Moore's  peptonised  milk  when  they  have  rejected 
aiilk  in  every  other  form. 
*  "  Regime  des  Phthisiques.    Du  Regime  Alimentaire,"  p.  400. 


Chap.  VIII.]  Milk  m  Phthisis.  483 

Some  physicians  consider  it  impoi-tant  that  the 
milk  should  be  drunk  almost  immediately  after  it  has 
been  drawn  from  the  cow,  and  that  it  is  more  diges- 
tible and  nutritious  when  perfectly  fresh  than  after  it 
has  been  boiled. 

Jaccoud*  makes  a  great  point  of  phthisical 
patients  who  dwell  in  the  country  drinking  the  milk 
in  the  cow's  stables,  not  only  that  they  may  thus  get 
the  milk  perfectly  fresh,  but  that  they  may  breathe 
the  atmosphere  of  the  stables  for  a  short  period  two 
or  three  times  a  day.  He  says  he  is  very  sui'e  that 
this  atmosphere  has  the  effect  of  allaying  bronchial 
and  laryngeal  irritations,  and  of  relieving  cough. 

He  also  considers  that  the  addition  of  some  form 
of  alcohol  (brandy,  rum,  or  kirsch)  presents  the  double 
advantage  of  being  useful  in  itself  and  promoting  the 
digestibility  of  the  milk. 

Germain  S^e  considers  the  peculiar  value  of  milk 
in  phthisis  to  depend  upon  the  fat  it  contains,  and  he 
argues  that  when  enough  milk  is  taken  to  provide 
the  requisite  amount  of  the  other  elements  necessary 
for  the  nutrition  of  the  body,  the  fatty  constituents 
ai-e  in  large  excess,  and  this  he  regards  as  its  great 
recommendation.  For  an  exclusively  milk  diet,  he 
estimates  the  necessary  quantity  at  three  litres  daily 
(105  ounces),  rather  more  than  five  imperial  pints. 

In  many  summer  health-resorts  in  Switzerland 
and  Germany  provision  is  made  for  following  a  "  milk 
or  whey  cure,"  and  in  most  of  these  sheep's,  goat's, 
and  ass's  milk,  as  well  as  cow's  milk,  can  be  pi'ocured. 
There  is  no  reason,  however,  for  believing  that  goat's 
milk  is  more  digestible  than  cow's  milk ;  but,  in  the 
case  of  diarrhoea,  it  is  thought  to  be  preferable  on 
account  of  the  lime  salts  it  contains.  Ass's  milk, 
however,  like  mare's  milk,  can  often  be  taken  when 
cow's  milk  has  proved  indigestible. 

Some  of  the  older  physicians,  who  highly  prized 
ass's  milk  in  the  treatment  of  phthisis,  took  great 
pains  in  seeing  to  the  feeding  of  the  animals  that 

*  "  Curability  et  Traitement  de  la  Phthisie  Pulmonaire." 
F  F   2 


484  Food  in  Disease.  [Pan  11. 

yielded  the  milk — pains  which  we  may  well  believe 
were  not  wholly  wasted  ;  *  more  recently  Latour  added 
large  quantities  of  common  salt  to  the  food  of  goats 
in  order  to  obtain  milk  largely  charged  with  what  he 
considered  a  valuable  i-emedy  in  the  treatment  of 
phtliisis. 

It  is,  perhaps,  well  to  remember  that  the  con- 
sumption of  large  quantities  of  milk,  to  the  exclusion 
of  other  food,  occasionally  leads  to  ti'oublesome  con- 
stipation, and  that  this  may  often  be  remedied  by 
mixing  a  little  seltzer-water  with  the  milk. 

Kouviiss,  or  fermented  mare's  milk,  has  acquired 
a  great  reputation  in  Russia  in  the  treatment  of 
pulmonary  tuberculosis,  and  the  Russians  resoi-t  in 
considerable  lunnbers  to  those  stations  on  the  borders 
of  the  Caspian  Sea,  amongst  the  Kirghis  and  Tartar 
tribes,  where  the  koumiss  cure  is  carried  on.  How 
much  of  the  good  results  obtained  at  these  stations  is 
to  be  attributed  to  the'  pure  aseptic  air  breathed  in 
these  extensive  plains  and  how  much  to  the  koumiss 
it  is  not  possible  to  estimate  ;  but  there  can  be  no 
doubt  that  many  phthisical  patients  derive  much 
benefit  from  following  this  course.f  The  Russian 
koumiss  is  prepared  from  animals  kept  at  liberty,  and 
not  worked.  Mare's  milk,  owing  to  the  large  amount 
of  lactose  it  contains,  readily  undergoes  fermentation, 
the  result  of  which  is  the  production  of  a  sour,  highly 
gaseous  fluid  containing  alcohol,  carbonic  acid,  and 
lactic  acid. 

In  Europe  it  is  now  lai-gely  prepared  from  cow's 
milk.  The  cows  should  be  fed  in  open  pastures,  and 
special  means  are  adopted  to  diminish  the  relative 
amount  of  casein  and  increase  the  relative  amount  of 
sugar  contained  in  cow's  milk.  It  must  be  regarded 
as  a  food  intermediate  in  character  between  milk  and 
alcohol — more   stimulating    than    the    former,    more 

*  Vide  Fonssagrives,  "  Th^rapeutique  de  la  Phthisie  Pulmon- 
aire,"  p.  235. 

t  The  establishments  kept  by  Dr.  Postnikoff  and  Dr.  AnnaeflE 
at  Ssamara  can  be  recommended  to  those  who  may  wish  to  try  the 
Koiuniss  cure  in  the  Bussian  steppes. 


Chap,  VIII.]  Food  in  Fnrinr.is.  485 

tonic  than  the  latter.  Unfortunately,  many  persons 
cannot  overcome  their  dislike  to  it  as  a  beverage. 
When  it  is  well  borne,  it  is  found  to  be  easy  of 
digestion,  often  relieving  dyspepsia  and  vomiting,  and 
producing  increase  of  weight.  It  is  appropriate  to 
febrile  cases,  as  it  quenches  thirst,  and  can  often  be 
retained  in  the  stomach  when  all  other  food  is  re- 
jected ;  indeed,  its  especial  value  is  in  those  cases  of 
inveterate  dyspepsia  and  gastric  irritability  in  which 
all  attempts  at  giving  other  kinds  of  food  have  failed. 
Galazynie  and  kefir,  employed  for  the  same  purpose  as 
koumiss,  have  been  already  desciibed. 

The  utility  of  fatty  substances  in  phthisis  is 
undoubted,  and  in  those  cases  in  which  we  encounter 
an  insuperable  difficulty  in  procuring  the  acceptance 
or  the  digestion  of  cod-liver  oil,  we  may  encourage 
our  patients  to  consume  as  much  fresh  butter  and 
good  cream  as  they  can  digest. 

Excellent  results  have  been  obtained,  even  in 
some  advanced  cases,  from  the  administration  of 
cream.  We  have  already  mentioned  a  suitable  mode 
of  giving  it.  Some  order  a  little  rum  or  brandy  to 
be  mixed  with  it.  The  addition  of  sugar  or  salt  is 
said  to  aid  its  digestion ;  or  it  may  be  mixed  with 
a  little  tea  or  coffee,  when  these  beverages  do  not 
disagree. 

Cocoa  and  chocolate  are  useful  forms  of  food,  and 
contain  a  notable  quantity  of  fat.  Savory  and  Moore's 
peptonised  cocoa  and  milk  is  very  useful.  Cocoa,  as  a 
beverage,  is  more  digestible  when  made  with  water 
than  when  made  with  milk. 

Pancreatic  emulsion  will  be  found  of  service  in 
many  cases  where  there  is  difficulty  in  tolerating 
other  forms  of  fatty  food. 

Of  the  various  forms  of  animal  food,  well-cooked 
beef,  mutton,  chicken,  and  game  ;  clear  turtle  soup ; 
oysters;  many  kinds  of  tish — soles,  whiting,  turbot, 
cod,  herrings,  flounders,  smelts,  brill — are  all  suitable 
to  vary  the  diet  of  the  phthisical. 

The  use  of  raw  meat  has  been  highly  extolled, 


486  Food  in  Disease.  [Part  ii. 

especially  by  some  French  physicians,  and  Professor 
Faster,  of  Montpellier,  has  claimed  the  most  brilliant 
results  from  its  administration  in  cases  of  phthisis. 
These  results  have  not,  however,  been  confirmed  by 
other  observers,  although  it  is  generally  admitted  that 
in  many  cases  of  troublesome  dypepsia  and  loss  of 
appetite,  especially  when  associated  with  diarrhoea, 
raw  meat  has  rendered  real  service. 

Various  expedients  have  been  adopted  to  overcome 
the  repugnance  which  most  patients  at  first  manifest 
for  this  form  of  food. 

In  all  cases  it  should  first  be  reduced  to  as  fine  a 
state  of  subdivision  as  possible  by  scraping  or  cutting 
and  pounding,  or,  better  still,  by  the  use  of  the  little 
machines  now  made  for  this  purpose.*  Raw  meat 
may  also  be  reduced  to  a  fine  dry  powder  by  first 
drying  and  then  grinding  it. 

Pounded  raw  meat  can,  moreover,  be  made  up  into 
small  round  pellets,  and  covered  with  powdered  sugar 
or  gum  or  any  other  innocent  covering,  and  swallowed 
with  a  little  wine  and  water  or  brandy  and  water ; 
or  it  can  be  mixed  with  a  little  hot  clear  soup.  And 
it  goes  especially  well  mixed  with  light  tapioca  soup ; 
this  can  be  flavoured  with  any  agreeable  flavouring 
and  drunk  readily,  and  the  mouth  cleansed  by  drink- 
ing a  few  mouthfuls  of  weak  brandy  and  water  or 
claret  and  water  after  it. 

The  sending  of  phthisical  patients  to  slaughter- 
houses to  drink  the  raw  hlood  of  animals  as  they  are 
killed  is  more  sensational  and  whimsical  than  rational 
and  eflicacious. 

Loomis  (H.  C)  has  strongly  advocated  the  use  of 
heef  juice  in  phthisis,  obtained  in  the  manner  he  thus 

*  Diibove  recommends  that  it  should  be  "scraped  with  a  knife, 
so  as  to  detach  all  the  muscular  fibres  and  separate  them  from  the 
fibrous  tissues ; "  and  he  points  out  that  what  renders  it  so  valu- 
able as  a  food  is  its  extreme  subdivision,  which  multiplies  the 
surfaces  of  contact  and  allows  each  fibre  to  be  completely  bathed 
by  the  digestive  juices  ;  also,  as  it  lias  not  been  hardened  by 
cooking,  it  allows  tliese  juices  to  penetrate  it  more  readily. — "La 
Tuberculosa  Parasitaire,    p.  77. 


Chap.  VIII.]  Food  in  Phthisis.  487 

describes  :  "  To  obtain  from  the  meat  the  maximum 
amount  of  juice,  a  meat-squeezer  is  absolutely 
essential.  The  best  kind  of  meat  from  which  to 
squeeze  the  juice  is  a  thick  round  steak,  free  from  fat. 
This  should  be  seasoned  with  pepper  and  salt,  broiled 
over  a  quick  fire,  then  cut  in  pieces  two  inches  square, 
and  then  put  into  the  meat  squeezer.  About  8  oz. 
of  juice  can  be  obtained  from  each  pound  of  meat. 
No  heat  can  be  applied  to  this  juice,  as  the  albumin 
would  be  at  once  coagulated  and  the  juice  rendered 
more  than  useless.  If  the  juice  becomes  cold  and  it 
is  advisable  to  heat  it,  this  can  be  best  accomplished 
by  placing  the  cup  in  hot  water.  It  is  necessary  to 
go  fully  into  the  preparation  of  this  beef  juice, 
because  of  its  importance  as  one  of  the  most  essential 
items  in  the  diet  of  phthisis.  Freshly-squeezed  beef 
juice  is  the  best  of  the  artificial  preparations  of  meat 
known,  and  the  trouble  of  preparing  it  is  well  repaid 
by  the  marked  improvement  in  the  patient." 

In  some  pai'ts  of  Germany  the  roes  of  salted 
herrings,  and  in  France  several  species  of  snails,  are 
thought  to  be  especially  useful  as  food  for  the  phthisical. 

The  different  kinds  of  farinaceous  foods  are  all 
useful  and  appropriate  articles  of  diet.  Whole  meal 
or  well-made  brown  bx-ead  is,  on  account  of  the  phos- 
phates contained  in  it,  better  suited  to  young  con- 
sumptives, if  they  digest  it  well,  than  white  bread. 
Lentil  flour  is  also  valuable,  as  it  contains  notable 
proportions  of  phosphates  and  iron.  Oatmeal  is 
rich  in  fatty  matters,  and  the  flour  of  maize  is  still 
richer — a  fact  which  renders  them  both  very  suitable 
additions  to  the  diet  of  the  tuberculous. 

Malt  Extract  is  now  largely  employed  as  an  addi- 
tion to  farinaceous  food,  the  digestion  and  assimila- 
tion of  which  the  diastase  contained  in  it  doubtless 
facilitates. 

It  is  possible  also  to  procure  malt  bread  and  malt 
biscuits. 

With  regard  to  the  use  of  alcoholic  beverages 
much  diflerence  of  opinion  exists. 


488  Food  in  Disease.  tPartii. 

Some  advocate;  the  consumption  of  large  quan- 
tities of  alcohol  in  phthisis.  Flint*  quoted  cases 
which  appeared  to  have  been  benefited  by  the  con- 
sumption of  as  much  as  a  pint  of  whisky  daily  !  We 
shall  find,  practically,  that  the  use  and  need  of 
alcohol  vary  greatly  in  different  individuals. 

Tn  some  it  diminishes  appetite  and  retards  diges- 
tion ;  in  others  it  promotes  both ;  and  we  shall 
encounter  very  few  cases  of  phthisis  which  are  not 
benefited,  at  some  period  of  their  course,  by  the  dis- 
creet administration  of  alcoholic  stimulants. 

Germain  See  deduces  from  experimental  data  the 
following  conclusions  as  to  the  use  of  alcohol  in 
tuberculosis  : — 

(«)  If  there  is  fever  it  moderates  it. 
(h)  If  there  is  no  fever  it  supjjorts  the  strength, 
(c)  In  all  cases   it   diminishes  bodily   waste  and 
emaciation. 

It  is  noteworthy,  also,  that  physicians,  likeBrehmer 
of  Gbbersdorf  and  Dettweiler  of  Falkenstein,  who 
have  quite  excei)tional  experience  of  the  daily  needs 
of  phthisical  patients,  use  alcohol  largely. 

Every  additional  year's  experience  convinces  us 
that  most  of  the  reputed  harm  accruing  from  the  use  of 
alcoholic  stimulants  in  phthisis  is  due  to  the  want  of 
care  and  discrimination  in  the  choice  of  the  bcvei-age  used. 

It  is  exceedingly  necessary  that  tlie  beverage, 
whether  wine,  spirits,  or  beer,  should  be  pure  and  of 
the  best  quality. 

When  the  patient  is  able  to  drink  fermented  malt 
liquors,  he  may  be  allowed  one  or  two  pints  daily  of 
good  sound  bitter  beer,  or  porter,  or  stout ;  of  wines, 
a  half  a  pint  to  a  pint  of  really  good  Bordeaux  or 
Burgundy,  or  of  some  of  the  better  descrij)tions  of 
Hungarian,  and  Italian,  or  Greek  wines.  Port  and 
sherry  we  have  found  objectionable  in  most  ca.ses,  dis- 
turbing digestion,  and  often  causing  headaches  ;  a  pro- 
IMJrtionate  quantity  of  whisky  or  brandy  is  preferable 

*  In  bis  work  on  "Phthisis." 


Chap,  viii.]    SuRALiMENTATiON  IN  Phthisis.        489 

to  either  of  these  wines.  Avoid,  with  the  greatest 
care,  cheap,  bad,  acid  clarets,  the  extended  consump- 
tion of  which  does  infinite  mischief ;  most  Australian 
wines  also  are  heavy  and  difficult  of  digestion. 

In  febrile  cases,  small  quantities  of  alcohol  given 
frequently  have  an  excellent  effect  in  supporting  the 
strength ;  and  especially  during  the  night  is  it  im- 
portant to  give  two  or  three  table.spoonfuls  of  brandy 
or  whisky,  alone,  or  with  a  little  fluid  food,  such  as 
milk,  or  beef-tea,  or  a  whipped  egg. 

What  is  termed  by  the  French  physicians  "  ali- 
inentation  forc4e  " — i.e.  forced  feeding — is  an  expe- 
dient suggested  by  Dx*.  Ddbove  of  Paris  for  intro- 
ducing food  in  large  quantities  into  the  stomachs  of 
phthisical  patients  who  have  lost  all  appetite,  or  even 
acquired  a  positive  repugnance  for  food. 

Debove  also  maintains  that  his  method  of  artificial 
alimentation,  with  or  without  a  previous  washing  out 
of  the  stomach  ("  lavage  de  Vestomac ")  with  iced 
water,  is  a  most  efficacious  measure  for  arresting  the 
vomiting  of  phthisical  patients. 

Debove  discovered,  by  accident,  that  in  cases  in 
which  all  food  introduced  into  the  stomach  in  the 
ordinary  way  was  rejected  by  vomiting,  food  intro- 
duced by  the  oesophageal  tube  wa.s,  strange  to  say, 
retained ;  and  on  this  observation  he  founded  his 
method  of  artificial  '^  suralimentation."  He  finds  he 
is  able  to  introduce  by  this  means  into  the  stomach 
an  "excess"  of  food  which  is  retained  and  digested; 
and  he  truly  observes  that  a  j)erson  with  phthisis  re- 
quires considerably  more  food  than  a  person  in  health 
on  account  of  the  considerably  greater  bodily  waste 
taking  place.  He  has  also  observed  that  the  digestive 
power  of  the  patient  has  no  relation  with  appetite, 
"  A  patient  who  has  no  appetite,  or  who  has  a  marked 
disgust  for  all  food,  will  digest  perfectly  a  large  meal 
introduced  by  the  tube,  and  even  at  the  end  of  a 
certain  time  will  recover  appetite."  * 

*  "  Le9on8  Cliuiques  et  Thcrapeutiques  sur  la  Tuberculose 
Furasitaire,"  p.  82. 


49°  Food  in  Disease.  [Pan  ii. 

As  the  results  of  sur alimentation,  or  excess  of 
food,  he  has  observed  disappearance  of  night  sweats, 
diminution  and  disappearance  of  cough  and  expectora- 
tion, increase  of  strength,  rapid  gain  in  weiglit,  and  at 
the  same  time  a  considei-able  araeliox'ation  in  the 
physical  signs. 

By  the  use  of  powdered  raw  meat,  Debove,  and 
Dujardin-Beaunietz  in  Paris,  and  Peiper  in  Griefs 
wald,  have  been  able  to  apply  the  principle  of  sur 
alimentation  without  the  necessity  of  using  the 
oesophageal  tube. 

Dujardin-Beaumetz  gives  the  following  instructions 
for  making  this  powder  : — Take  the  lean  of  beef,  cut 
it  up  into  small  pieces,  dry  it  in  a  water-bath  ;  wlicn 
thorouglily  dried  reduce  it  to  powder  in  a  coffee-mill, 
or  by  means  of  a  machine  constructed  by  Galante 
(No.  2,  Rue  de  I'Ecole  de  Medecine,  Paris).  This 
powder  can  be  mixed  with  lentil  flour,  an  I  taken  in 
the  form  of  soup,  or,  better  still,  it  may  be  mixed 
with  chocolate,  or  with  grog — "  r/roc/  de  la  poudre  de 
viande."  To  make  tlie  latter,  you  place  in  a  bowl  two 
tablespoonfuls  of  meat  powder,  to  this  you  add  three 
dessertspoonfuls  of  "  syrup  of  punch "  (essence  of 
rum  punch),  and  enough  milk  to  make  a  perfectly 
fluid  mixture.  By  these  means  you  can  give  from 
1,500  to  6,000  grains  of  meat  powder  daily ;  *  the 
latter  quantity  would  be  equivalent  to  24,000  grains, 
or  three  and  a  half  pounds  of  raw  meat.  Or  it  may 
be  given,  as  recommended  by  Debove,  simply  mixed 
with  milk ;  first  adding  just  enough  milk  to  make  a 
smooth  paste,  and  then  mixing  in  the  remainder  so  as 
to  make  a  uniform  fluid  mixture  that  can  be  readily 
drunk.  It  is  necessary  in  using  these  powders  to  see 
that  they  are  genuine,  and  not  over  dried. 

Debove  attempts  to  exjilain  the  beneficial  efi'ect  of 
"  surali  mentation  "  in  the  following  manner: — "The 
tubercle  bacillus  develops  in  a  certain  soil,  a  soil 
which  becomes  less  favourable  to  its  culture  when  it 
is  modified  by  suralimentation  [excess  of  food  ]  ;  this, 
*  Dujardin-Beaumetz,  "L'Hygiene  Alimentaire,"  Paris,  1887. 


ciiap.  VIII.]    Daily  Dietary  IN  Phthisis.  491 

indeed,  augments  combustion,  as  is  shown  by  the 
amounts  of  urea  excreted  in  the  twenty-four  hours — 
amounts  whicli  reach  900  grains,  1,200  grains,  and 
even  more.  We  may  also  say  that  by  this  method  we 
give  our  patients  the  power  to  resist  their  disease ;  as 
when  the  vine  is  attacked  by  the  phylloxera,  one  of 
the  best  remedies  is  to  manure  well  the  land  ;  by  so 
doing,  we  do  not  destroy  the  parasite,  but  we  give  the 
plant  the  force  necessary  to  struggle  against  it." 

Since  the  adoption  of  powdered  raw  meat  for  sur- 
alime)itation,  the  introduction  of  food  into  the  stomach 
by  means  of  the  oesophageal  tube  is  I'eserved  for  those 
cases  in  which,  owing  to  irritability  of  the  gastric 
mucous  membrane,  food  taken  in  the  ordinary  way 
cannot  be  retained  in  the  stomach. 

While  we  should  do  all  in  our  power  to  encourage 
our  phthisical  patients  to  tsike  an  abundance  of 
nourishing  food  (and  for  this  purpose  we  should  make 
their  diet  as  varied  and  attractive  as  possible),  we 
must  be  careful  not  to  admit  into  their  dietary  forms 
of  food  which,  although  attractive  to  the  patient,  tend 
to  exhaust  his  digestive  forces  without  rendering  him 
an  equivalent  amount  of  support  and  nourishment. 
We  should,  therefore,  exclude  pastry,  uncooked  fruits, 
salads,  pickles,  and  all  forms  of  indigestible  food.  H. 
Weber  objects  to  potatoes  on  account  of  the  amount 
of  potash  they  contain.  "  Experience  shows  that  the 
exclusive  or  even  preponderating  use  of  potatoes 
favours  scrofula." 

It  would  be  undesirable  to  tix  too  rigidly  the  daily 
dietary  of  the  phthisical,  but  the  following  scheme 
may  serve  as  a  general  guide — a  sort  of  plan  of  route 
from  which  wide  excursions  may  be  made  under  the 
guidance  of  a  discreet  physician  : — 

Oil  waking  in  the  morning,  a  tumblerful  of  milk 
should  be  taken  mixed  with  a  little  hot  water,  to 
which  it  is  often  useful  to  add  a  few  gi*ains  of 
common  salt  and  bicarbonate  of  soda,  especially  when 
a  certain  amount  of  accumulated  mucus  has  to  be 
got  rid  of  by  expectoi'ation.     There  is  no  objection  to 


492  Food  in  Disease.  iPartii, 

taking  a  little  tea,  coffee,  or  cocoa  at  this  hour,  with 
milk  or  cream,  if  preferred.  Sometimes  the  stimulus 
of  a  tablespoonf  ul  of  brandy,  rum,  or  whisky  is  needed 
at  this  time.  The  first  meal  is  often  best  taken  in 
bed.  About  an  hour  afterwards  a  substantial 
breakfast  should  be  taken,  consisting  either  of  broiled 
bacon  and  lightly-boiled  eggs,  or  some  fresh  fish,  or 
some  cold  meat  or  game  or  poultry,  and  with  this 
meal  milk,  or  cocoa  or  cofiee  or  tea,  or  some  good 
sound  light  wine  and  water  may  be  taken,  according 
to  taste. 

Supposing  this  meal  to  be  taken  about  nine  or 
ten  o'clock,  a  glass  of  milk  or  a  cup  of  beef-tea 
should  be  taken  about  noon. 

Half-past  one  or  two  o'clock  is  a  good  hour  for 
the  chief  meal  of  the  day.  This  should  consist  of 
some  fish  when  it  can  be  procured  fresh  and  good, 
together  with  some  meat,  chicken  or  game,  and  fresh 
vegetable ;  and  some  light  milk-pudding  with  a  little 
marmalade  or  other  cooked  fruit.  With  this  meal 
half  a  pint  of  good  Hungarian  wine,  light  claret,  or 
Burgundy,  or  an  equivalent  quantity  of  brandy  or 
whisky  and  water,  may  be  taken. 

At  five  in  the  afternoon  another  glass  of  milk 
should  be  taken,  or  a  cup  of  thin  chocolate,  or  tea 
with  plenty  of  milk  or  cream ;  or  the  yolk  of  an  egg 
beaten  up  with  a  little  brandy  and  water  may  be 
substituted,  if  preferred.  It  is  rarely  desirable  to 
order  any  solid  food  at  this  hour  if  it  is  intended  that 
the  patient  should  make  another  substantial  meal  at 
seven.  At  this  hour  a  meal  similar  in  all  respects  to 
that  taken  at  1.30  or  2  o'clock  should  conclude  the 
substantial  feeding  of  the  day. 

About  half  an  hour  before  bed-time  (which  should 
not  be  later  than  10  or  10.30  p.m.)  another  glass  of 
milk,  prepared  in  the  same  manner  as  that  in  the 
morning,  together  with  one  or  two  tablespoonfuls  of 
brandy  or  whisky  ;  or  a  cup  of  arrowroot,  or  beef-tea, 
or  tapioca  soup,  according  to  taste,  may  be  taken. 
And,    finally,    some    provision   of  light   nourishment 


Chap.  VIII.)    Daily  Dietary  in  Phthisis.  493 

mixed  with  a  little  stimulant  should  be  arranged 
in  order  to  be  taken  during  the  night  when  woke 
by  coughing  or  after  perspiration,  or  when  merely 
restless. 

A  glass  of  Vichy  water,  taken  warm,  half  an 
hour  before  meals,  as  recommended  by  G.  S6e,  may 
be  found  useful  in  some  cases  and  to  jiromote  the 
secretion  of  gastric  juice. 

In  distinctly  febrile  cases  a  much  more  fluid 
dietary  will  have  to  be  followed,  and  the  food  will 
require  to  be  taken  at  shorter  intervals. 


494 


CHAPTER    TX. 

DIET    IN    AFFECTIONS    OF    THE    CIRCULATORY    AND 
RESPIRATORY    ORGANS. 

The  diseases  to  which  we  shall  refer  in  this  and  the 
following  chapter  are,  speaking  generally,  less 
directly  amenable  to  dietetic  treatment  than  those 
we  have  previously  had  under  consideration.  Some 
of  them,  siich  as  acute  rheumatism,  for  example,  and 
its  complications,  would  naturally  fall  under  those 
general  dietetic  instructions  which  we  have  given  for 
the  management  of  febrile  maladies.  The  same 
remark  will,  of  course,  also  apply  to  acute  affections 
of  the  respiratory  organs  and  to  acute  febrile  dis- 
turbances of  the  circulatory  system.  It  is  on  this 
account  that  we  shall  be  able  to  deal  somewhat 
briefly  with  the  dietetic  management  of  most  of  these 
maladies. 

With  regard  to  afTections  of  the  circulatory 
system.  In  chronic  cardiac  valvular  disease,  when 
compensation  is  well  maintained,  no  very  rigorous 
dietary  is  neces.sary,  but  a  few  general  rules  may  be 
laid  down,  with  advantage,  for  the  guidance  of  these 
cardiac  patients.  They  should  avoid,  for  the  most  part, 
all  foods  which  tend  to  excite  an  undue  amount  of 
gastro-intestinal  fermentation — for  by  causing  flatu- 
k;tit  distension  of  the  abdomen,  and  so  pu.shing  up 
the  diaphragm,  the  cardiac  region  is  encroached  upon 
and  the  circulatory  difficulties  are  thereby  greatly  in- 
creased, and  palpitation  or  a  sense  of  oppression  at  the 
heart,  and  dyspnoea  are  apt  to  be  excited.  Pastry, 
entrees,  stews  of  all  kinds,  saccharine  and  farinaceous 
foods,  should  be  avoided.  The  meals  should  not  be 
too  copious,  so  as  to  over-distend  the  stomach.     They 


Chap.  IX.]        Diet  in  Cardiac  Disease.  495 

should  be  strictly  moderate  in  quantity,  well  cooked, 
and  in  an  easily  digestible  form.  The  meals  also 
should  not  be  in  too  quick  succession,  but  ample  time 
should  be  given  for  the  digestion  of  one  meal  before 
another  is  taken.  TeS  and  coffee  should  be  only 
taken  in  small  quantities  at  a  time,  not  sti-ong,  and 
not  with  food.  China  tea  is  to  be  preferred,  for 
reasons  already  given.  It  is  best  to  take  but 
very  little  fluid  while  eating,  but  to  drink  what  is 
needed  slowly,  after  a  meal.  All  malt  liquors  should 
be  avoided,  and  very  little  if  any  alcohol  taken.  The 
principal  meal  is  best  taken  in  the  middle  of  the  day ; 
the  evening  meal  should  be  a  light  one. 

When  in  these  cases  dyspeptic  troubles  arise  from 
temporary  portal  obstruction  and  congestion  of  the 
gastro-intestinal  mucous  membrane,  the  patient  should 
be  put  on  very  light  food,  and  the  drinking  a  glass  of 
Vichy  water  half  an  hour  before  each  meal  is  often 
very  useful. 

The  pliysicians  of  the  Paris  school  often  have 
recourse  for  a  time  to  an  exchisive  milk  diet  in  these 
cases  of  cardiac  dyspepsia :  this  gives  rest  to  the 
stomach,  and  by  promoting  free  diuresis  tends  to 
lower  vascular  tension,  and  to  regulate  the  circula- 
tion. After  a  time  the  ordinaxy  diet  may  be  resumed, 
avoiding  always  those  fermentable  foods  already 
referred  to.  Tobacco  should  be  prohibited,  as  its  use 
is  apt  to  hasten  the  approach  of  the  stage  of  loss  of 
compensation. 

When  comjyeiisation  fails,  attention  to  dietetic  rules 
becomes  more  necessaiy.  In  these  cases  the  French 
physicians  are  very  greatly  in  favour  of  an  exclusive 
milk  diet  for  a  time  —  partly  because  it  favours 
diuresis,  and  so  tends  to  obviate  the  occurrence  or 
aggravation  of  dropsical  effusions.  Alcohol  in  some 
form,  and  in  modei-ate  quantity,  is  often  now  needed 
occasionally,  and  two  or  three  tablespoonfuls  of 
whisky  or  sound  brandy  in  the  twenty-four  hours, 
well  diluted  with  water,  is,  on  the  whole,  the  most 
suitable. 


496  Food  in  Disease.  [Part  ii. 

It  is  especially  important  in  these  cases  care- 
fully to  avoid  an  excess  of  fluid,  for  an  excessive 
ingestion  of  fluid  over  distends  the  blood-vessels, 
heightens  arterial  tension,  overtaxes  tlie  heart, 
disturbs  the  efforts  at  com{)ensation,  and  promotes 
congestion,  oedema,  and  anasarca. 

But  in  avoiding  an  excess  of  fluid  we  must  not  go 
to  the  other  extreme — too  little  fluid  has  also  its 
dangers.  It  may  lower  arterial  pressure  dangerously, 
and  may  retard  the  elimination  of  excretory  sub- 
stances through  the  renal  and  other  channels.  A 
certain  amount  of  water  is  absolutely  necessary  for 
solvent  and  excretory  purposes. 

The  amount  of  fluid  permitted  must  be  estimated 
in  each  case  accoi'ding  to  its  special  features,  the  condi- 
tion of  the  vessels,  and  the  character  of  the  excretions. 

We  have  already  alluded  to  the  tendency  in 
chronic  valvular  diseases  to  the  occm-rence  of  dyspeptic 
troubles;  these  are  necessarily  more  prone  to  arise  in 
non-compensated  cases  than  in  compensated  ones, 
and  are  closely  dependent  on  the  hepatic  engorgement 
and  gastro-intestinal  catarrh  caused  by  the  back- 
pressure of  the  blood.  What  we  have  said  in  another 
chapter  of  the  dietetic  treatment  of  chronic  gastric 
catarrh  will  apply  to  these  cases.  Concentrated  fluid 
foods  or  predigested  foods  are  often  best  suited  to 
many  of  these  cases.  Milk,  whipped  eggs,  light  clear 
consomm^,  may  be  taken  at  moderately  short  inter- 
vals— three  or  four  hours ;  then,  when  improvement 
of  the  gastric  functions  has  set  in,  we  may  give  some 
pounded  underdone  beef  or  other  meat,  chicken,  or 
white  fish.  The  object  should  be  to  give  small 
quantities  of  concentrated  and  easily  digested  food, 
and  to  take  care  that  the  stomach  is  never  over- 
distended  by  too  copious  a  meal,  or  by  the  frequent 
repetition  of  meals. 

All  coarse  and  readily  fermentable  foods  are  to  be 
eschewed,  and  particularly  saccharin,  farinaceous, 
and  fatty  foods.  All  wines,  beers,  efl''ervescing  drinks, 
are,  as  a  rule,  best  avoided. 


Chap.  IX.]       Diet  IN  Arteriosclerosis.  497 

Occasionally  a  small  cup  of  coffee  or  China  tea, 
taken  by  itself,  may  be  pei*mitted ;  but  in  some  cases 
these  beverages  are  apt  to  excite  flatulent  dyspepsia, 
and  must  then  be  abandoned. 

Some  attention  must  be  paid  to  the  tendency  to 
constipation  which  is  usually  present  in  these  cases, 
and  some  cooked  fruit  pulp,  or  stewed  prunes  or  tigs, 
or  some  vegetable  pur^e — made  without  meat  gravy — 
may  be  advantageously  added  to  the  dietary. 

It  is  necessary  in  children  with  chronic  valvular 
disease  to  watch  carefully  their  food  habits.  All 
gorging  must  be  provided  against,  and  the  diet 
should  be  of  extreme  simplicity — milk  and  light  milk- 
puddings,  with  a  little  fruit  juice  are  suitable,  but 
pastry  and  sweets  should  be  strictly  forbidden. 

Cases  of  artei'io-sclcrosis  may,  no  doubt,  be 
favourably  influenced  by  diet,  especially  those  cases 
in  which  renal  changes  are  present  or  imminent.  In 
many  of  these  cases,  again,  the  French  school  approve 
of  the  adoption  of  a  milk  diet — especially  with  the 
view  of  eliminating  toxic  substances  by  the  kidneys — 
but  it  is  only  necessary  in  a  limited  number  of  cases 
to  apply  an  exclusive  milk  diet.  A  mixed  diet  may 
be  taken  by  the  gi-eater  number,  and  this  may  consist 
of  milk,  fresh  vegetables,  a  few  eggs,  and  well-cooked 
fresh  meat.  But  it  is  to  be  borne  in  mind  that  meat 
is  the  chief  source  of  '^alimentary  toxins,"  and  its 
consumption  should  be  reduced  to  a  minimum.  Pork, 
high  game,  all  meat  stews  and  twice-cooked  meat, 
meat  gravies,  greasy  soups,  soups  that  may  contain 
ptomaines,  preserved  meats,  shell-fish,  and  Crustacea, 
must  be  avoided. 

An  exclusive  milk  diet  has  been  found  of  value 
in  those  cases  that  are  accompanied  with  rebellious 
headaches  and  grave  dyspncea.  Its  value  depends 
upon  the  fact  that,  as  a  food,  it  brings  into  tiie 
or^'  nism  the  least  amount  of  toxic  substances,  and 
that  it  acts  as  a  diuretic  and  so  eliminates  nitrogenous 
waste.  As  Professor  Potain  has  said,  "  it  is  useful 
because  it  is  not  hurtful."      "  It  is  marvellous  to  see 


498  Food  in  Disease,  tPartii. 

with  what  readiness,  under  tlie  influence  of  an 
absolute  milk  diet,  disapi)ear  tlie  attacks  of  nocturnal 
distress,  the  insomnia,  the  headaches.  At  the  end 
of  two  or  three  days  the  transformation  is  sometimes 
complete,  and  the  patient  who  used  to  pass  his  nights 
seated  in  an  armchair  can  sleep  in  peaceful  sleep."* 
The  milk  diet  must  not  be  continued  too  long,  as 
patients  soon  tire  of  it.  Wlien  the  serious  symptoms 
have  disappeared,  it  is  best  to  return  gradually  to  a 
mixed  diet,  diminishing  proportionately  the  quantity 
of  milk  ;  but  the  patient  should  still  take  milk  freely, 
and  it  should  form  the  chief  constituent  of  his  evening 
meal. 

The  digestion  of  the  milk  will  often  be  facilitated 
by  adding  to  it  a  third  or  fourth  part  of  Vichy  or 
Vals  water,  and  the  addition  of  a  little  brandy, 
whisky,  kirsch,  or  other  aromatic  liquors  will  often 
make  it  more  agreeable  to  the  patient,  and  relieve,  to 
a  certain  extent,  the  feeling  of  weakness  and  languor 
often  experienced  when  on  this  exclusive  diet. 

In  all  these  eases,  as  in  cases  of  cardiac  valvular 
disease,  the  quantity  as  well  as  the  quality  of  tlie 
beverages  taken  must  be  strictly  regulated — for  the 
absorption  of  a  large  quantity  of  drink  may  heighten 
injuriously  the  arterial  tension.  We  must,  therefore, 
limit  the  amount  of  drink  taken  at  meals,  while,  for 
reasons  already  stated,  we  must  avoid  a  rigorously 
dry  diet. 

It  is  best,  when  possible,  to  avoid  wine  and  spirits 
altogether,  or  to  allow  at  most  a  little  white  wine 
with  some  table-water,  the  eflervescence  having  been 
allowed  to  pass  off. 

Dilatation  of  the  heart  from  weakness  of  the 
myocardium,  such  as  is  found  after  certain  acute  in- 
fective diseases,  and  such  as  forms  a  part  of  the  clinical 
features  of  the  "senile  lieart"  so  well  described  by 
Dr.  Balfour,  calls  for  much  consideration  in  connection 
with   its    appropriate    dietetic  treatment;    and   Dr. 

•  "Clinique  Therapeutique,"  par  Dr.  Gaston  Lyon,  p.    555. 
Paris,  1895. 


Chap,  ix.i      Diet  in  the  Senile  Heart.  499 

Balfour  has   fully  entered   into  the  details   of   this 
question.* 

We  have  already  anticipated  some  of  these  con- 
siderations in  our  remarks  on  the  diet  suitable  in 
arteriosclerosis,  which  very  frequently  accompanies 
the  senile  heart,  and  throughout  this  work  we  have 
repeatedly  called  attention  to  many  of  the  precepts 
which  Dr.  Balfour  also  enforces. 

In  the  lirst  place  he  maintains  that  over-indulgence 
in  food  in  advanced  life  is  often  the  cause  of  and 
distinctly  aggravates  the  cardiac  loss  of  tone,  for  in 
those  with  weak  hearts  the  gastric  juice  is  both 
deficient  in  quantity  and  defective  in  quality.  There- 
fore the  food  should  be  strictly  limited  in  quantity 
and  not  made  bulky  by  too  great  dilution  with 
fluids. 

He  takes  much  pains  to  point  out  the  value  of  a 
dry  diet  in  those  cases  in  which  there  are  indica- 
tions of  "soakage  of  the  tissues."  He  observes: 
"  When  there  is  anasarca  or  any  evidence  of  soakage 
in  any  depending  part  of  the  body,  it  is  of  the 
greatest  importance  to  place  the  patient  for  a  time, 
at  least,  on  the  driest  possible  diet,  and  not  too  much 
of  it.  .  .  .  The  relief  obtained  by  this  strict  diet  is 
both  remarkable  and  immediate.  I  have  seen  a  con- 
siderable amount  of  oedema  of  the  lower  limbs 
disappear  within  twenty-four  hours,  before  there 
had  been  time  for  any  change  in  the  heart,  which 
was  feeble  and  dilated."! 

The  following  is  the  dry  diet  formulated  by 
Balfour : — 

Breakfast. — A  slice  of  dry  toast,  about  li  oz. ;  no 
butter;  one  cup  of  tea  with  cream  and  sugar;  not 
more  than  4  oz. 

Dinner. — The  lean  of  two  chops,  not  more,  or  its 
equivalent  in  chicken  or  fish ;  no  vegetables ;  dry 
toast  d  volonte,  Brandy  or  whisky,  -}  oz.  in  3  oz.  of 
water. 

•  "  The  Senile  Heart,"  by  Dr.  G.  AV.  Balfour.    1894. 
+   "  The  Senile  Heart,"  p.  252. 

G    G    2 


500  Food  in  Disease.  [Pan  ii. 

Supper. — Dry  toast  a  volontL  Brandy  or  whisky, 
\  oz.  in  3  oz.  of  water. 

If  thirsty,  the  patient  may  be  permitted  to  sip 
slowly  3  or  4  oz.  of  hot  water  about  an  hour  before 
each  meal. 

We  abstract  also  another  dietary  of  Dr.  Balfour's 
construction,  which  he  considers  a  good  one,  "  to 
begin  with,"  in  cases  of  weak  heart,  and  in  which 
thsre  is  a  definite  limitation  of  both  solids  and  liquids. 
It  is  a  more  generous  diet  than  the  preceding,  which 
is  obviously  only  suitable  for  temporary  adoption  : — 

Breakfast.- — Dry  toast,  about  \\  oz.,  with  butter; 
1  e^g,  or  half  a  small  haddock,  or  an  equivalent 
quantity  of  other  fresh  white  fish.  Tea  or  coffee,  3  to 
5  oz.,  with  cream  or  sugar.  Infusion  of  cocoa-nibs, 
or  milk  and  hot  water,  or  cream  and  seltzer-water, 
may  be,  if  desired,  substituted  for  the  tea.  If  oat- 
meal porridge  be  taken,  nothiiuj  else  nmst  be  taken 
with  it,  and  not  moi'e  than  3  or  4  oz.  of  oatmeal  and 
4  or  5  oz.  of  cream. 

Dinner  at  1.30  to  2  o'clock,  of  two  courses  only  : 
fish  and  meat,  or  fish  and  pudding,  or  meat  and 
pudding ;  no  soups,  pastry,  pickles,  or  cheese.  Half 
a  haddock,  or  its  equivalent  in  any  other  white  fish, 
boiled  in  milk,  steamed  or  broiled,  never  fried. 
Wing  and  part  of  the  breast  of  a  chicken,  or  its 
equivalent  in  sweetbread,  tripe,  game,  or  mutton  ; 
one  potato,  or  a  little  spinach.  The  pudding  should 
be  a  simple  milk  pudding,  cr  about  \  lb.  of  such  fruit 
as  jiears,  apples,  grapes,  etc.,  instead,  either  cooked  or 
uncooked.  4  or  5  oz.  of  water  may,  if  wished,  be 
sipped  during  this  meal. 

Tea. — 5  to  6  p.m.,  3  to  4  oz.,  no  paiticle  of  solid 
food  with  it,  but  cream  and  sugar,  if  Avished.  Hot 
water,  4  to  5  oz.,  may  be  taken  instead  of  it,  with,  if 
needed,  a  teaspoonful  of  Liebig's  Extract. 

Stipper. — 7  p.m.  White  fish  and  a  potato,  or 
toast  with  butter,  or  some  milk  pudding,  or  Revalenta 
made  with  milk  or  with  Liebig's  Extract. 

At  bed-time,  4  or  5  oz.  of  water. 


Chap.  IX.]  Diet  in  ANEURYS^ia.  501 

'*  On  such  a  dietary  a  weak  digestion  from  a 
feeble  heart  will  gi'adually  recover  its  tone,  and  the 
patient  will  feel  comfortable  instead  of  being  puffy 
and  oppres.sed  after  meals,  with  an  irregular  and 
trembling  heart."  *  If  the  patient  loses  flesh  too 
rapidly,  the  diet  must  be  made  more  nutritious  ;  if 
the  patient  is  obese,  and  slow  in.  thinning,  a  little 
more  self-denial,  especially  in  the  fluids,  will  be  re- 
quired. 

The  following  are  the  four  dietetic  rules  Balfour 
formulates  for  all  those  with  weak  hearts,  and  they 
agree  in  the  main  with  our  own  experience  : — 

1.  There  must  never  be  less  than  5  hours  between 
each  meal. 

2.  No  solid  food  is  ever  to  be  taken  between 
meals. 

3.  All  those  with  weak  hearts  should  have  tlieir 
principal  meal  in  the  middle  of  the  day. 

4.  All  those  with  weak  hearts  should  have  their 
meals  as  dry  as  possible. 

It  is  especially  necessary  with  these  patients  that 
there  should  be  a  sufficiently  long  interval  between 
meals,  for  in  persons  with  weak  hearts  and  feeble 
circulation,  digestion  is  slower  than  in  the  healthy 
and  strong,  and  at  least  5  hours  is  needed  for  the 
digestion  of  a  meal.  For  the  same  reason  it  is 
most  important  that  no  solid  food  should  be  taken 
between  meals,  as  it  tends  to  arrest  the  incompleted 
digestive  process  and  provokes  flatulence  and  acidity. 
It  is,  howevei',  often  an  advantage  to  take  some  hot 
fluid  3  or  4  hours  after  a  meal,  as  it  will  often  start 
afresh  a  flagging  digastion  and  wash  the  remains  of  the 
meal  out  of  the  stomach. 

A  few  remarks  on  the  dietetic  treatment  of 
aneurysm  will  conclude  what  we  have  to  say  with 
regard  to  feeding  in  disorders  of  the  cii'culation. 
The  severe  and  rigorous  dietetic  treatment  which 
used  formerly  to  be  applied  in  cases  of  internal 
aneurysm  is  rarely  employed  now.  Our  own  ex- 
*  "TVip  «tenile  Heart,"  p.  248. 


502  Food  IN  Disease.  tPanii. 

I)erience  has  shown  that  so  far  from  uniformly 
quieting  the  circulation  and  slowing  the  action  of  the 
heart,  in  some  cases  it  produces  a  sort  of  nervous 
excitement  of  the  circulation  and  a  quick  and  weak 
heart-beat  is  often  the  result.  At  the  same  time 
the  anaemic  and  depressed  nutrition,  following  the 
extreme  abstention  and  enforced  repose,  has  seemed 
to  us  often  to  lead  to  further  distension  of  the 
aneurysmal  sac.  Better  results  are  certainly  obtained 
now  in  the  treatment  of  aortic  aneurysm  by  the 
administration  of  potassium  iodide,  together  with  a 
quiet  restful  life  and  a  moderate  amount  of  food, 
avoiding  especially  too  much  fluid,  so  that  there  shall 
be  no  over-distension  of  the  vessels.  TufnelVs  diet, 
which  has  very  frequently  been  applied  to  the  treat- 
ment of  aneuiysm — associated  with  prolonged  absolute 
rest  in  bed  in  the  horizontal  position — is  constructed 
as  follows  : — 

Breakfast. —  2  oz.  of  bread  with  a  little  butter, 
and  2  oz.  of  milk. 

Dinner. — From  2  to  3  oz.  of  meat  without  salt, 
and  4  oz.  of  milk  or  claret. 

Supper. — The  same  as  breakfast. 

This  diet  has  been  found  useful  in  certain  form8 
of  aneurysm  probably  of  traumatic  origin,  but  it  is 
rarely  useful  in  those  cases  which  depend  on  de- 
generative changes  in  the  vessels ;  in  such  cases  a 
dietary  limited  to  simple  forms  of  food,  and  suf- 
ficiently moderate  in  amount  to  avoid  any  risk  of 
vascular  over-distension  or  cardiac  excitement,  is  best; 
and  especially  should  we  ensure  a  careful  re.striction 
in  the  quantity  of  fluids  permitted,  even  if  the  patient 
should  suffer  somewhat  from  thirst,  which  may 
usually  be  appeased  by  sipping  a  little  acidulated 
water. 

We  now  pass  to  the  consideration  of  diet  in 
diseases  o/" <^?  respiratory  org^ans.  There  are  few 
diseases   of  the  respiratory  organs  that  are  in  any 


Chap.  IX.]      Diet  IN  Respiratory  Diseases.      503 

direct  sense  under  the  special  influence  of  diet,  and 
such  general  rules  as  our  readers  must  now  be 
familiar  with  will  serve  for  their  guidance  in  most 
acute  and  many  chronic  respiratory  affections. 

What  we  have  said  elsewhere*  on  this  subject,  we 
may  repeat  hei*e ;  and,  first,  with  respect  to  diet  in 
acute  pneumonia.  In  this  disease  the  diet  should  be 
fluid  and  light,  and  adapted  to  the  enfeebled  digestive 
powers  and  to  the  febrile  state.  Milk,  well  diluted 
with  water,  or  some  effervescing  alkaline  water  when 
there  is  any  tendency  to  sickness,  is  a  good  and 
convenient  food.  The  occasional  vomiting  of  coagu- 
lated milk  should  be  carefully  noted,  for  it  then 
usually  requires  further  dilution  with  some  alkaline 
water,  or  it  should  be  peptonised.  Light,  clear  soups 
and  broths  may  also  be  given,  and  there  is  no  harm 
in  a  cup  of  well-made  tea  or  coffee  now  and  then, 
and  they  are  both  cardiac  stimulants.  Strong  coffee 
is  too  little  used  in  these  cases.  It  has  a  tonic  effect 
on  the  heart.  Thirst  may  be  allayed  and  the  mouth 
kept  clean  and  moist  by  sipping  iced  lemonade,  toast- 
and-water,  or  barley-water,  according  to  choice. 

When  more  stimulating  food  seems  called  for, 
eggs  may  be  given  beaten  up  with  boiling  water  and 
one  or  two  dessertspoonfuls  of  brandy  or  whisky 
added.  Strong  beef-tea  or  meat  juice,  and  thin  arrow- 
root may  also  be  given,  with  some  added  spirit,  in  the 
same  way.  If  tliere  is  co-existing  bronchial  catarrh, 
and  the  expectoration  is  viscid  and  difficult  of  ex- 
pulsion, hot  milk  and  seltzer-water  in  equal  parts, 
with  2  or  3  teaspoonfuls  of  brandy,  serves  both  as  a 
stimulating  food  and  a  useful  expectorant.  With 
regard  to  tlie  use  of  alcoholic  stimulants,  we  are  con- 
vinced that  in  more  than  two-thirds  of  the  cases  of 
acute  pneumonia,  as  they  are  generally  encountered, 
there  is  no  need  of  them  whatever. 

The  routine  administration  of  alcohol  in  pneu- 
monia, especially  in  the  early  stages,  with  the  idea  of 

♦  "Manual  of  Medical  Trentment,"  fourth  edition,  Part  III., 
chnp.  5. 


504  Food  in  Disease.  [Partii. 

preventing  cardiac  failure,  is,  we  think,  a  seriqus 
error.  Alcohol  produces  vasomotor  pai'esis  and 
causes  dilatation  of  the  vessels  and  it  must  therefore  ag- 
gravate or  induce  tendencies  to  vascular  engorgement. 

It  acts  like  a  poison  to  many  persons,  and  causes 
considerable  nervous  and  general  depression  after  its 
first  stimulating  (iffect  passes  off;  it  increases  the 
amount  of  toxic  substances  in  the  blood,  and  the 
elimination  of  considerable  quantities  of  alcohol  must 
impose  a  severe  strain  on  the  already  overtaxed  organs 
of  excretion.  When  we  further  consider  the  large 
quantity  of  impure  spirit — brandy  and  whisky — 
which  must  be  used  in  hospital  practice — for  the  pure 
and  best  kinds  are  costly — we  are  disposed  to  believe 
that  some  of  the  more  serious  forms  of  cardiac  failure, 
with  albuminuria  and  gastric  and  hepatic  congestion, 
encountered  in  the  later  stage  of  pneumonia  are,  to  a 
certain  extent,  contributed  to  by  the  excessive  and 
premature  use  of  impure  alcohol.  The  early  routine 
use  of  alcohol  takes  from  us  also  the  power  of  resort- 
ing to  it  as  a  fresh  resom-ce  in  advanced  stages,  when 
in  exceptional  cases  it  may  be  of  undoubted  use. 

In  well-marked  adynamic  cases,  however,  the  use 
of  alcohol  is  indicated,  and  we  should  make  some 
efforts  to  obtain  it  ])ure.  In  the  pneumonia  of 
drunkards  and  the  aged  it  is  especially  needed.  We 
should  begin  with  moderate  amounts — 4  to  6  oz. 
of  whisky  or  brandy  in  twenty-four  hours — and 
increase  them  if  necessary.  Dr.  Wilson  Fox  thus 
formulated  tiie  indications  for  its  use: — "Rapidity, 
irregularity,  intermittence,  and  dicrotism  of  the  pulse, 
great  rapidity  of  respiration,  cyanosis  with  a  rapid, 
feeble  pulse,  irregularity  of  breathing,  and  signs  of 
pulmonary  cedema,  tremor,  sub.sultus,  muttering 
delirium,  or  delirium  in  patients  addicted  to  alcohol- 
ism, and  profuse  sweating  during  the  febrile  period, 
are  all  indications  for  alcohol.  When  these  symptoms 
are  severe,  alcohol  must  occasionally  be  used  un- 
flinchingly and  unsparingly."  * 

*  "  Diseases  of  the  Lungs,"  p.  372. 


Chap.  IX.]     Diet  in  Respiratory  Diseases.      505 

A  moderate  amount  of  alcoholic  stimulant  in  the 
form  of  good  sound  wine,  such  as  port  or  Burgundy, 
or  champagne  if  it  is  preferred,  or  2  to  3  oz.  of  whisky 
or  brandy  in  the  day,  is  often  needed  after  the  crisis 
and  during  convalescence.  It  will  then  be  of  much 
help  in  restoiing  the  strength  of  the  patient. 

In  acute  hroncho-pneiimonia  alcohol  will  be  needed 
in  most  ca-ses  to  prevent  j)rostration  and  to  maintain 
the  strength.  In  very  young  children  10  or  15 
drops  of  brandy  or  whisky  may  be  given  in  a  few 
teaspoonfuls  of  hot  milk  and  water  every  hour,  and 
this  dose  may  be  increased  to  half  a  teaspoonful, 
or  a  teaspoonful  in  older  children.  When  collapse 
is  threatened,  brandy  and  whisky  may  be  given 
hypodermically  or  by  the  rectum,  mixed  with  some 
fluid  food.  The  food  must  be  light  and  nourishing, 
good  broths,  good  beef-tea,  grtiel,  milk,  whipped  eggs 
with  milk  or  whey,  may  be  given.  If  there  should  be 
much  gastric  irritability  and  difficulty  of  swallowing, 
from  great  dyspnoea,  nutrient  eneraata  must  be 
administered. 

In  acute  bronchitis  the  diet  during  the  attack,  if 
it  be  a  severe  one,  should  be,  in  the  main,  fluid. 
Milk,  when  it  is  well  borne  and  easily  digested,  is 
excellent;  it  should  usually  be  given  warm.  Nourish- 
ing, clear  soups,  gruel  and  broths,  which  favour 
diaphoresis  and  expectoration,  should  also  be  given. 
Beaten-up  eggs,  the  yolks  of  lightly -boiled  or  poached 
eggs,  and  custard  puddings,  are  all  useful.  Light 
puddings,  tapioca,  ground  rice,  or  arrowroot,  are 
permissible,  and  if  the  tongue  is  fairly  clean,  a 
little  pounded  meat  or  chicken  may  be  added  to  the 
animal  broth.s.  An  occasional  cup  of  light  tea  is 
refreshing  and  stimulating.  In  the  slighter  cases 
fish  and  chicken  are  permissible.  In  convalescence 
we  should  prescribe  a  nourishing  diet,  carefully 
adapted  to  the  digestive  capacities  of  individual 
patients. 

In  pleurisy  with  a  considerable  amount  of  fluid 
effusion,  the  adoption  of  a  diet  from  which  fluids  are 


5o6  Food  in  Disease.  [Partii. 

to  a  great  extent  excluded  has  never  become  popular 
or  largely  practised  in  England,  and  although  one 
would  naturally  counsel  a  strict  limitation  of  fluids  to 
■what  is  simply  necessary  to  allay  thirst,  we  can  see  no 
good  reason  for  tormenting  the  patient  with  distressing 
dietetic  restrictions  when,  if  it  is  important  to  remove 
the  effused  fluid,  it  can  readily  be  done,  to  any  extent, 
by  puncture  and  aspiration. 

In  such  cases,  if  free  from  fever,  we  should  allow 
easily  digested  solid  foods,  such  as  pounded  meat, 
chicken,  white  game  and  fish,  some  light  puddings  or 
bread  and  milk,  and  bread-and-butter,  and  some 
stewed  fruit  pulp.  If  we  limit  the  amoiint  of  fluid 
taken  in  the  twenty-four  hours  to  30  oz. — to  consist 
of  milk  and  water,  weak  tea,  or  light  soup — and  if  at 
the  same  time  the  functions  of  the  kidneys,  bowels, 
and  skin  are  promoted  by  suitable  medicines,  the 
loss  of  water  by  the  excretory  organs  should  be  in 
excess  of  the  intake,  and  the  absorption  of  the  fluid 
exuded  may  thus  be  pi'omoted.  We  should  avoid  a 
fluid  diet  if  possible,  and  feed  the  patient  on  nourish- 
ing and  easily  digested  solids. 

In  Germany  some  physicians  have  advocated  the 
adoption  of  Schrotts's  dry  diet,  consisting  of  lean 
roast  veal  and  stale  rolls,  with  no  fluid  but  a  little 
water  for  three  days,  and  then  half  a  pint  of  red  wine 
is  allowed,  and  this,  at  the  end  of  the  week,  is  in- 
creased to  a  pint. 

In  the  management  of  cases  of  asthma  attention 
to  diet  is  of  much  importance,  and  the  same  may  be 
said  of  cases  of  advanced  emphysema  attended  with 
dyspnceic  attacks.  It  has  repeatedly  been  observed 
that  the  occurrence  of  asthmatic  paroxysms  frequently 
follows  carelessness  in  feeding  and  is  commonly 
induced  by  disturbances  of  digestion.  Subjects  of 
asthma  should  therefore  be  advised  to  take  great 
care  to  avoid  indigestible  forms  of  food,  and  especially 
those  things  which  they  have  learnt  by  experience 
tend  to  provoke  a  paroxysm  of  asthma.  Suppers  and 
late  dinners  should  be  firmly  prohibited,  and  the  chief 


Chap.  IX.]  Diet  in  Asthma.  507 

meal  should  always  be  taken  in  the  middle  of  the  day, 
and  nothing  but  a  little  light  fluid  food  in  the  evening 
— about  two  or  three  hours  before  bed-time. 

Asthmatics  should  avoid  all  coarse  and  indigestible 
articles  of  diet.  They  should  select  the  lean  of  tender 
mutton  and  beef,  and  the  best  parts  of  chicken,  white 
game  and  white  fish ;  or  such  meats  may  be  reduced 
to  pulp  in  a  mincing  machine  before  cooking,  as 
described  in  our  account  of  the  Salisbury  method 
(page  458).  While  it  is  not  desirable  they  should  do 
without  fresh  vegetables,  these  should  be  cooked  in 
the  form  of  purees,  and  a  well-made  pur^e  of  spinach 
or  lettuce  is  very  wholesome.  A  little  light  pudding 
with  the  pulp  of  cooked  fruit  is  also  useful.  Saccharin, 
farinaceous  and  fatty  foods,  as  tending  to  excite 
fermentation,  should  be  restricted  to  very  small 
amounts,  and  sho\ild  consist  of  such  light  puddings 
as  sago,  rice,  tapioca,  macaroni,  vermicelli,  and  the 
like,  and  these  may  be  eaten  with  a  little  fruit  pulp 
or  jelly. 

Eggs  lightly  cooked  or  whipped  up  with  hot  milk 
are  a  very  convenient  form  of  food. 

The  meals  should  be  small  and  concentrated,  and 
only  a  small  quantity  of  fluid  sipped  at  meal-times — 
just  sufficient  to  enable  the  patient  to  eat  his  food  in 
comfort.  It  is,  however,  a  good  plan  to  order  a  glass 
of  hot  water  in  which  a  few  grains  of  sodium  bicar- 
bonate have  been  dissolved  to  be  drunk  slowly  half  an 
hour  before  meals,  and  again  at  bed-time.  This  will 
diminish  the  desire  to  drink  at  meals.  It  will  be 
found  that  most  asthmatic  patients  require  a  certain 
amount  of  alcohol,  especially  in  catarrhal  cases,  for  a 
tablespoonful  of  spirit  (whisky  or  brandy)  with  a 
little  hot  milk  and  seltzer-water  often  acts  as  a  good 
expectorant.  Strong  coffee  is  well  known  to  bo  often 
of  use  in  allaying  the  asthmatic  paroxysms;  it  is 
therefore  advisable  in  these  cases  to  reserve  it  for 
that  purpose. 


So8 


CHAPTER    X. 

FOOD  IN  ACUTE  AND  CHRONIC  RHKUMATISM,  AND  IN 
RHEUMATOID  ARTHRITIS — IN  SKIN  DISEASES  — 
IN   INSANITY  AND  CERTAIN  OTHER   AFFECTIONS   OP 

THE      NERVOUS       SYSTEM  BENEKE's      DIET       FOB 

CANCER. 

The  diet  in  acute  rlicuinatisiti  must  be  to  a  great 
extent  the  same  as  is  suitable  in  otlier  acute  febrile 
maladies.  While  the  fever  and  joint  inflammation 
are  present  the  food  should  be  of  the  lightest  possible 
kind,  cooling,  and  entirely  fluid.  We  have  elsewhere* 
recommended  that  a  jug  containing  a  pint  of  milk 
diluted  with  a  pint  of  boiled  water,  and  containing 
30  to  40  grains  of  sodium  bicarbonate  and  10  to  20 
grains  of  common  salt,  and  cooletl  by  a  lump  of  ice, 
should  be  kept  near  the  patient,  and  a  tumblerful 
given  frequently.  In  this  way  3  to  4  pints  of  milk 
may  be  taken  in  twenty-four  hours.  Fresh  lemonade 
made  to  eflervesce,  and  neutralised  by  the  addition  of 
potassium  bicarbonate,  may  also  be  drunk  freely. 

The  free  consumption  of  these  i)loasant  alkaline, 
cooling,  and  at  the  same  time  sufficiently  nutritious 
drinks,  answers  the  important  purpose  of  altering  and 
improving  the  blocxl  condition  by  diluting  noxious 
substances  in  it,  while  it  supplies  the  great  loss  of 
water  that  is  taking  place  from  the  skin,  and  it  helps 
to  maintain  the  alkalinity  of  the  fluids.  Whey  may 
be  taken  instead  of  milk  if  the  latter  should  by 
chance  disagree,  which  it  is  not  likely  to  do  if  given 
in  the  manner  here  suggested.  Thin  oatmeal  gruel 
and  barley-water  may  also  be  taken  as  well  as  milk  — 
but  all  meat  extracts  or  animal  broths  are  particularly 

•  "Manual  of  Medical  Treatment,"  4th  edition,  vol.  ii.  p.  455. 


Chap.  X.]  Diet  in  Rheumatism.  509 

counter-indicated  in  the  febrile  stage  and  when  the 
urine  is  dense  and  high-coloured.  A  cup  of  weak 
tea  may  be  taken  from  time  to  time  if  desii"ed.  After 
the  febrile  stage,  light  clear  soups  and  bx'oths  may  be 
given,  flavoured  with  fresh  vegetables  and  savoury 
herbs.  A  little  pounded  beef  or  chicken  and  some 
crumb  of  stale  bread  may  be  mixed  with  the  soups  ; 
light  puddings,  bread  and  milk,  and  such  foods,  are 
also  suitable,  but  saccharine  things  are  to  be  avoided. 
There  is  no  need  for  alcohol  except  in  exceptional 
cases.  In  unduly  protracted  cases  some  form  of 
light  animal  nourishment  may  have  to  be  given, 
although  the  temperature  may  still  be  febrile.  We 
prefer  pounded  fresh  meat  added  to  light  broth  rather 
than  strong  meat  extracts. 

Tf  a  prolonged  convalescence  is  associated  with 
marked  symptoms  of  anaemia,  it  may  be  advisable  to 
give  a  little  wine  ;  one  or  two  glasses  of  dry  port, 
that  has  matured  in  the  wood,  or  the  same  quantity 
of  a  sound  Burgundy  diluted  with  water,  may  be 
prescribed. 

Caution  must  be  observed  in  permitting  a  return 
to  solid  food.  A  relapse  has  sometimes  been  traced 
to  the  premature  indulgence  in  meat.  It  is  as  well 
to  allow  from  a  week  to  a  fortnight  to  elapse  after 
the  temperature  has  fallen  to  normal  before  intro- 
ducing meat  or  tish  into  the  dietary.  Then  the  food 
may  be  gradually  changed  to  solids,  of  which  eggs, 
white  flsh,  and  chicken  are  the  best  to  begin  with  ; 
pounded  lean  beef,  mutton,  or  veal  may  also  be  ttiken. 
Such  vegetables  as  stewed  celery,  a  little  mashed 
potato,  spinach,  sea-kale,  and  asparagus  may  be 
permitted,  and  the  pulp  of  fresh  fruit,  such  as  baked 
apples,  etc. 

No  pastry,  sweets,  or  fermented  drinks  should  be 
allowed.  In  anfemic  cases  requiring  extra  food  a 
few  sandwiches  of  jjounded  meat  may  be  introduced 
between  meals  if  the  digestive  powers  are  acti\e. 

Clii'onic  rlieiimatisni  occurs  in  such  a  variety 
of  forms  and  under  such  vai-ying  circumstances  that  it 


5IO  Food  in  Disease.  [Partii. 

is  not  possible  to  prescribe  a  diet  that  shall  be  equally 
suitable  to  all  cases  ;  but,  speaking  generally,  one  may 
say  that  the  food  of  such  patients  should  be  light, 
nutritious,  and  readily  digested.  The  digestive 
peculiarities  of  individual  patients  must  be  observed, 
and  as  nutritious  a  diet  prescribed  as  is  consistent 
with  the  maintenance  of  healthy  digestion.  What- 
ever food  tends  to  cause  assimilative  difficulties — a 
good  test  of  which  is  the  occurrence  of  deposits  of 
lithates  in  the  urine — should  be  prohibited. 

Fresh  tender  meat,  poultry,  game,  and  fish  in 
strict  moderation ;  fresh  vegetables,  stewed  celery, 
Spanish  onions,  lettuce,  watercress,  and  broccoli,  and 
ripe  and  cooked  fruits ;  rice,  tapioca,  and  other 
farinaceous  foods  ;  butter,  cream,  and  milk — all  these 
are  admissible,  provided  that  there  exists  no  digestive 
peculiarity  which  might  cause  any  of  them  to  disagree. 
A  purely  vegetarian  diet  has  been  found  suitable  by 
some  patients.  Fermented  alcoholic  drinks  are  best 
wholly  avoided.  Home-made  lemonade  and  plenty 
of  pure  water  are  the  best  beverages. 

In  the  disease  known  sometimes  as  rlieiimatoid 
sii'thi'itis,  and  better  as  osteo-arthritis — and  the 
affinity  of  which  with  rheumatic  affections  is  doubtful 
— as  generous  a  diet  is  needed  as  the  enfeebled 
digestive  functions  will  permit  of.  Animal  food  of 
the  best  quality  may  be  freely  introduced  into  the 
dietaiy  of  such  patients,  and  mutton,  chicken,  fish, 
eggs,  butter,  cream,  milk,  and  a  moderate  amount  of 
alcohol  stimulant,  may  all  be  partaken  o£  Cod-liver 
oil  is  often  well  borne  by  these  patients,  and  is  of 
undoubted  service,  as  well  as  the  fats  we  have 
mentioned  above.  When  febrile  exacerbations  occur 
the  food  must,  of  course,  be  modified  accordingly. 

Diseases  of  the  skin  are  in  a  very  limited 
degree  under  the  influence  of  diet.  In  speaking  of  the 
treatment  of  eczema,  Malcolm  Morris  maintains  that 
"  dietetic  treatment  is  utterly  useless  "  in  parasitic 
diseases  of  the  skin,  and  these  form  a  very  large 
proportion  of  the  whole  group  of  skin  affections.     He 


Chap.  X.]  Diet  in  Skin  Diseases.  511 

further  says  in.  respect  of  eczema: — "Patients  have 
been  most  carefully  dieted  for  long  periods  without 
their  eczema  being  in  the  slightest  degree  benefited  ; 
whereas  on  removing  all  restrictions  of  diet  and 
treating  the  afiection  by  local  remedies,  a  cure  has 
speedily  followed.  It  is  only  in  acute  forms  of 
eczema  that  beer  and  other  stimulants  need  be 
forbidden."  In  gouty  cases  the  same  dietetic  rules 
will  apply  as  in  other  gouty  manifestations. 

Cheadle  considers  that  infantile  eczema  is  often 
greatly  benefited  by  substitution  of  raw  meat  juice 
and  cream  for  milk  and  farinaceous  substances.  With 
regard  to  those  diseases  of  the  skin  which  are  especially 
connected  with  nervous  disturbance,  such  as  hyper- 
sesthesia,  pruritus,  erythema,  rosacea,  herpes,  pem- 
phigus, lichen,  and  many  others,  most  authorities 
forbid  all  food  of  a  stimulating  or  constipating 
character ;  "  avoid  whatever  causes  flushing  of  the 
face  lasting  for  some  time  after  a  meal."  Total 
abstinence  from  alcohol  should  also  as  a  rule  be 
enjoined. 

Certain  skin  eruptions,  as  urticaria  and  some 
forms  of  erythema^  are  undoubtedly  connected  with 
the  ingestion  of  certain  articles  of  diet  in  some 
individuals,  and  these  must,  of  course,  be  sought  out 
and  strictly  avoided.  The  disfiguring  eruption  acne 
is  believed  by  some  physicians  to  be  particularly 
under  the  influence  of  diet.  An  American  authority* 
states  that  it  is  caused  by  "  eating  buckwheat  cakes 
or  oatmeal,"  or  "  by  greasy  food — doughnuts,  sausages, 
cheese,  fried  meats,  ill-cooked  and  rich  pastry — excess 
of  sweets,  nuts,  and  other  indigestible  substances." 
These  things  should  be  prohibited.  He  would  also 
forbid  all  forms  of  alcohol,  as  well  as  tea  and  coffee. 
"A  tumblerful  of  hot  water  or  a  glass  of  Vichy 
should  be  drunk  before  each  meal."  If  Vichy  water 
is  drunk  it  should  be  taken  quite  half  an  hour  before 
the  meal.     In  other  words,  these  dietetic  directions 

♦  "Practical   Dietetics,"  by   Prof.    W.    G.    Tliompson,    M.D. 
London  :  Knapton,  18%. 


512  Food  IN  Disease.  [Partii. 

amount  to  this  :  if  dyspepsia  accoiupanies  these  skin 
disorders,  the  dyspepsia  must  be  treated  by  the  usual 
dietetic  measures. 

It  is  also  quite  possible  that  many  sufferers  from 
skin  afliections  will  be  found  to  be  addicted  to  dietetic 
excesses  generally,  or  in  respect  to  some  particular 
articles  of  diet ;  these  excesses  must,  of  course,  be 
arrested. 

Eczema  in  sucking  infants  may  be  to  some  extent 
dependent  on  errors  of  diet  in  the  mother,  and  these 
should  be  sought  for  and  rectified.  If  the  mother  is 
bilious,  dyspeptic,  and  constipated  these  conditions 
must  be  treated  on  general  principles.  The  infant  is 
sometimes  nursed  too  frequently  and  so  overfed,  or 
for  economical  reasons  the  child  is  suckled  too  long. 
The  occurrence  of  eczema  in  young  children  generally 
should  lead  us  to  investigate  their  diet  and  to  correct 
any  errors  we  may  discover  in  the  general  principles 
fully  laid  down  in  the  first  part  of  this  work. 

The  chief  practical  point  to  be  considered  in  con- 
nection with  the  feedings  of  the  insane  is  the  best 
method  of  introducing  food  into  the  system  when,  as 
in  cases  of  acute  mania,  melancliolia,  etc.,  the  patient 
obstinately  refuses  to  take  nourishment.  When  by 
means  of  '■'^ forced  feeding  ^^  large  quantities  of  nutri- 
tious, concentrated,  and  easily  digested  food  are 
introduced  into  the  patient's  alimentary  canal,  a  very 
remarkable  amelioration  in  his  mental  and  general 
condition  is  often  observed. 

It  is  a  somewhat  debated  question  whether  in 
"  forced  feeding  "  it  is  best  to  use  an  cesophagetil  or 
a  nasal  tube.  Dr.  Niel*  of  the  Warneford  Asylum, 
Oxford,  who  is  an  advocate  of  the  oesophageal  tube  for 
feeding  the  insane,  thus  clearly  and  minutely  describes 
the  process  to  be  followed.  He  premises  that  "  the 
repugnance  to  food,  the  constipation,  the  dry  mouth,  and 
the  foul  breath  "  of  the  violent  lunatic  "  are  symptoms 
of  deficient  innervation,"  which  disappear  when  the 
*  Bruiah  Medical  Journal,  January  27th,  1S'J4. 


Chap.  X.]  Feeding  the  Insane.  513 

nutrition  of  the  nervous  centres  is  restored,"  and  he 
supports  the  opinion  by  the  observation  that  food, 
although  given  forcibly  and  rapidly,  does  not  cause 
vomiting,  and  that  the  digestive  organs  gradually 
return  to  their  healthy  condition  under  a  simple  course 
of  abundant  alimentation. 

"  A  melancholiac,"  he  says,  "  should  be  weighed 
once  a  week,  and  if  the  weight  is  falling,  too  little 
nourishment  is  being  given.  When  refusal  of  food  is 
absolute  and  wasting  is  rapid,  one  entire  day  of  fasting 
is  all  that  should  be  allowed.  In  cases  where  some 
food  is  taken,  but  not  enough,  we  should  not  temporise, 
but  bo'dly  resort  to  forcible  feeding."  The  following 
is  his  method.  The  food  must  of  course  be  liquid  — 
such  as  custard  of  eggs  and  milk — but  variety  is  needed, 
and  especially  the  introduction  of  some  vegetable. 
He  begins  by  giving  two  eggs  in  a  quart  of  new  milk 
morning  and  evening.  For  dinner,  about  the  middle 
of  the  day,  a  ration  of  meat  pounded  fine  in  a  mortar, 
with  two  or  three  good-sized  potatoes,  which  is  added, 
with  two  eggs  rnd  a  cup  of  cream,  to  the  liquor  in 
wliich  the  meat  was  boiled,  the  whole  being  made  into 
a  smooth  piir^e  with  all  the  solid  particles  strained  off. 
If  this  last  point  is  not  attended  to,  the  feeding-tube 
will  be  choked  and  an  awkward  interruption  to  the 
operation  caused.  To  each  of  these  three  meals  a  dose 
of  cod-liver  oil  should  be  added,  gradually  increased  to 
a  tablespoonful. 

If  symptoms  of  exhaustion  are  at  all  marked,  from 
half  an  ounce  to  one  ounce  of  brandy  should  also  be 
added.  If  after  a  week  of  this  regimen  the  body 
weight  is  still  falling,  another  egg  must  be  added  to 
each  meal. 

The  operation  must  be  performed  in  a  well-lighted 
room,  with  a  mattress  on  the  floor,  in  the  full  light  of 
the  window,  and  a  pillow  on  the  end  of  tlie  mat- 
tress farthest  from  the  window.  There  must  be  a  clear 
space  of  three  feet  all  round  the  mattress. 

The  feeding  tube  should  be  of  flexible  material,  as 
thick  as  a  smallish  finger  and  soft  throughout  to  the 

II  H 


514  Food  in  Di'jEase.  [Partii. 

very  tip.  An  accident  can  hardly  liappen  with  such 
a  tube.  It  is  too  large  to  enter  the  larynx  and  too 
soft  to  perforate  the  stomach  or  oesophagus.  It  is  best 
to  have  the  cup  for  receiving  the  food  made  in  one 
piece  with  the  tube  and  of  the  same  material.  A 
screw  gag  of  plated  metal,  thin  at  the  tips  and  serrated 
to  prevent  it  from  slipping  ofl"  the  teeth,  is  required. 
The  food  should  be  contained  in  a  jug  with  handle  and 
spout  for  convenience  of  pouring  into  the  funnel. 
The  patient  is  prepared  by  removing  his  boots  and 
loosening  the  clothing  about  the  body  and  neck— if  a 
woman,  the  stays  are  unfastened  and  the  petticoats 
slackened.  Four  assistants  are  required  at  the  opera- 
tion— one  at  the  head,  one  at  the  feet,  and  one  at 
each  side. 

The  patient  is  made  to  stand  on  the  mattre.ss,  near 
the  window  and  with  his  face  to  the  light.  The  chief 
assistant  stands  close  behind  the  patient  and  puts  his 
arms  through  the  armpits  of  the  latter.  Those  at  the 
sides  grasp  the  arms  of  the  patient  at  the  wrists  with 
one  hand  and  at  the  elbow  with  the  other.  The  assist- 
ant at  the  feet,  standing  at  one  side,  puts  his  arms 
round  the  patient's  ankles  and  snatches  his  feet  from 
under  him,  while  the  others,  especially  the  chief  assist- 
ant, support  the  body  and  let  the  patient  gently  and 
quickly  down  on  the  mattress  on  his  back,  the  feet 
being  towards  the  window  and  the  head  being  on  the 
pillow. 

The  light  must  fall  on  the  patient's  face.  A 
doubled  counterpane,  kept  in  roadines.s,  is  now  thrown 
across  the  patient's  body  so  as  to  cover  him  from , 
shoulders  to  waist,  the  arms  being  under  the  counter- 
pane and  close  to  the  sides.  The  chief  assistant  takes 
the  head  firmly  between  his  knees,  kneeling  behind 
the  patient,  the  back  of  whose  head  rests  on  the 
pillow.*  The  second  assistant  kneels  astride  the 
patient's  legs,  and  grasping  the  knees  with  his  hands, 
presses  them  downwards.  Those  on  the  sides  kneel 
on  the  loose  ends  of  the  counterpane  close  to  the 
patient's  body,  grasp  the  elbows  with  one  hand  and  the 


Chap,  x.]  Feeding  the  Insane.  515 

wrists  with  the  other  through  the  counterpane,  and 
press  downward  on  the  mattress. 

In  this  way  the  patient  is  completely  controlled  in 
a  few  seconds,  and  a  prolonged  struggle  causing  terror 
and  exhaustion  is  impossible.  The  chief  assistant 
tucks  the  towel  under  tlie  chin  to  prevent  the  clothes 
being  soiled.  The  assistants  must  avoid  kneeling  on 
the  patient  and  must  not  grasp  his  hare,  wrists.  That 
must  be  done  through  the  counterpane  or  the  sleeve 
of  the  coat  or  dress.  The  operator  now  kneels  at  the 
right-hand  side  of  the  patient's  head,  having  the 
instruments  and  vessels  on  the  floor  at  his  own  right 
hand.  He  oils  the  tube  and  lays  it  across  the  patient's 
chest,  on  the  towel,  to  be  ready.  He  then  inserts  the 
gag  between  the  molars  and  opens  the  mouth  widely 
with  the  screw.  When  the  mouth  is  well  opened,  the 
gag  is  entrusted  to  the  chief  assistant  to  keep  steadily 
in  position. 

The  operator  then  takes  the  oiled  tube  with  his 
left  hand  near  the  cup  end,  and  with  his  right  hand 
about  eight  inches  from  the  point.  Introducing  the 
point  into  the  pharynx,  he  guides  it  gently  down 
the  gullet  into  the  stomach.  The  stomach  is  known 
to  be  reached  by  the  feeling  of  resistance  ceasing  and  by 
a  puff  of  gas  that  comes  through  the  tube  with  a  slight 
gurgling  sound.  If  the  point  should  hitch  against  the 
back  of  the  pharynx,  the  tube  doubles  forward  at  its 
weakest  part,  where  the  eyes  are  pierced,  and  pressing 
on  the  larynx  causes  violent  dyspnoea.  This  is  less 
likely  to  happen  if  the  patient's  head  is  kept  a  little 
flexed.  The  tube  should,  if  this  happens,  be  with- 
drawn, the  head  flexed,  and  then  the  tube  re-introduced 
and  with  the  right  fore -finger  in  the  pharynx,  guiding 
the  point  into  the  oesophagus.  Sometimes  the  tube 
is  grasped  by  spasm  of  the  gullet ;  in  that  case  hold 
the  tube  against  the  obstruction  for  a  few  seconds, 
when  the  spasm  will  relax  and  the  tube  will  pass 
down.  Then  holding  the  tube  upright  with  the  left 
hand,  with  the  right  pour  the  food  into  the  cup  as  fast 
as  it  will  go  down.     If  the  flow  ia  checked,  it  is  because 

HH  2 


5i6  Food  in  Disease.  (Partii 

the  eyes  of  the  tube  are  closely  applied  to  the  gastric 
mucous  membrane  and  are  thus  blocked,  or  because 
the  tube  is  doubled  in  tlie  stomach.  Withdraw  the 
tube  for  a  couple  of  inches  and  the  food  will  flow.  In 
some  cases  there  is  much  regurgitation  of  food, 
causing  troublesome  or  even  alarming  symptoms  of 
suffocation.  Lay  down  the  jug  and  suspend  the  ad- 
ministration of  food  by  pinching  the  soft  stem  of  the 
tube  with  the  right  fore-finger  and  thumb  till  the 
I'egurgitation  subsides;  then  go  on  again. 

When  all  the  food  is  given,  withdraw  the  tube 
gently,  keeping  it,  while  doing  so,  towards  the  roof 
of  the  mouth  to  avoid  tickling  the  epiglottis.  The 
patient  is  then  released.  Allow  him  to  lie  for  a  short 
time  to  lessen  the  risk  of  vomiting.  If  this  method 
be  followed  with  care  and  skill  it  ought  not  to  take 
more  than  four  and  a-half  minutes. 

Some  lunacy  specialists  prefer  feeding  by  the 
nares,  and  contend  that  feeding  by  the  nose  has  the 
following  advantages  over  mouth-feeding  : — No  injury 
is  done  to  the  mouth  or  teeth,  whereas  the  sci*ew- 
gag  must  cause  moi-e  or  less  soreness  and  injury, 
especially  when  used  for  any  length  of  time  in  a 
determined  subject,  and  moreover  it  has  an  embarrass- 
ing tendency  to  slip,  and  in  feeding  by  the  nose  the 
patient  seems  to  realise  sooner  that  he  is  mastered. 
To  these  objections  Dr.  Niel*  replies  that  the  nares 
are  sometimes  so  j)lugged  with  inspissated  mucus  that 
it  is  difficult  to  pass  the  tube — that  there  is  much 
uncertainty  where  the  slender  nasal  tube  may  go, 
and  that  the  risk  of  sending  such  a  tube  into  the 
larynx  and  passing  the  food  into  the  patient's  lungs 
instead  of  into  his  stomach  is  a  real  one,  and  is 
greatest  with  acute  melancholiacs,  who  always  resist 
to  some  extent,  and  often  frantically.  Mouth-feeding 
is  therefore  safei'.  He  also  maintains  that  the  screw- 
gag  does  not  slip  if  properly  held — that  the  danger 
to  the  teeth  has  been  exaggerated,  provided  the  gag 
be  carefully  introduced  and  carefully  withdrawn. 
♦  BHtish  Medical  Journal,  April  2l8t,  1894. 


Chap.  X.]  Diet  JN  Apoplexy.  517 

With  regard  to  the  dietetic  management  of  other 
diseases  of  the  nervous  system,  there  is  little  that  need 
be  said.  We  have  entered  fully  into  the  subject  of 
feeding  in  neurasthenic  cases,  and  in  most  other 
cases  of  nervous  disease  the  diet  has  to  be  arranged 
on  general  principles,  and  modified  and  adapted  to 
individual  cases  and  to  the  various  phases  of  the 
disease. 

In  acute  inciiing^itis  the  diet  must  be  of  the 
simplest — milk  mixed  with  ice-water  is  the  best  food. 
In  the  later  stages,  with  much  general  depression, 
beef-tea,  wine,  and  other  stimulants  and  restoratives 
may  be  called  for.  Rectal  feeding  will,  of  course,  be 
necessaiy  when  it  is  not  possible  to  give  food  by  the 
mouth. 

In  apoplexy  in  the  stage  of  unconsciousness  the 
tendency  on  the  part  of  anxious  friends  to  administer 
food  by  the  mouth,  when  the  patient  is  really  unable 
to  swallow,  must  be  restrained.  It  must  be  explained 
that  no  harm  can  arise  from  abstention  from  food  for 
a  day  or  two.  There  is,  however,  no  objection  to 
rectal  feeding  if  the  general  condition  of  the  patient 
points  to  the  need  of  nourishment  or  stimulant. 

In  cases  of  hemiplegia  occurring  without  loss  of 
consciousness  the  diet  should  be  simple  but  nutritious. 
On  the  recovery  of  consciousness  in  apoplectic  cases 
the  diet  should  be  very  light  and  unstimulating,  and 
should  consist  of  milk  and  farinaceous  foods  chiefly. 
Later,  when  the  hemiplegia  becomes  complicated 
with  rigidity  and  muscular  contractions,  the  diet 
should  still  be  light  and  nutritious,  but  not  exciting. 
It  is  best  to  avoid  animal  food,  or,  at  any  rate,  limit 
it  to  a  little  chicken  or  tish.  No  alcoholic  drinks, 
save  for  exceptional  reasons,  should  be  permitted ; 
and  strong  tea  and  coffee  are  best  avoided.  But  the 
digestive  })eculiarities  of  each  patient  must  be  studied, 
and  no  attempt  made  to  carry  out  a  hard-and-fast 
rule  as  to  diet.  A  strictly  vegetarian  diet,  with  milk, 
has  been  advocated,  and  this,  where  it  agrees  well,  is 
sound  advice,  but  where,  from  individual  peculiarities, 


5i8  Food  in  Disease.  (Partii. 

this  is  not  the  case,  it  is  worse  tlian  iiseless  to  insist 
on  such  a  strict  regime. 

Those  wlio  have  had  an  apoplectic  seizure,  in 
order  to  avoid  the  tendency  to  recurrence,  should 
be  cautioned  that  it  is  needful  to  observe  great 
moderation  in  eating  and  drinking  ;  the  diet  should 
consist  of  white  meats,  green  vegetables,  and  ripe 
fruits,  while  butcher's  meat,  fats,  and  saccharine 
substances  should  be  avoided. 

In  arranging  the  diet  in  cases  of  locomotor 
ataxia  the  chief  considerations  are  adequately  to 
maintain  the  nutrition  of  the  patient  without  disturb- 
ing his  digestive  functions.  As  generous  a  diet  should 
be  presented  as  the  patient  can  comfortably  digest;  and 
any  digestive  feebleness  should  be  carefully  studied, 
and  the  diet  adapted  to  it  accordingly.  When  they 
are  readily  digested,  a  free  consumption  of  fats  should 
be  encouraged,  such  as  butter,  bacon,  cream,  or  cod- 
liver  oil,  for  a  tendency  to  emaciation  is  usually 
encountered  in  chronic  cases.  Water  taken  freely 
is  useful  for  purposes  of  elimination ;  and  light 
wines  with  water,  or  light  beer,  may  be  permitted ; 
also  tea  and  coffee,  if  they  do  not  lead  to  digestive 
disorder. 

In  cases  of  insomnia  certain  food  habits  may 
need  modification  and  correction,  such,  for  instance, 
as  are  calculated  to  disturb  that  physical  and  organic 
calm,  at  the  time  of  retiring  to  rest,  which  is  needful, 
in  the  hyper-sensitive,  in  order  to  ensure  sleep. 

The  consumption  of  cardiac  excitants,  such  as  tea, 
coffee,  and,  with  some  jiersons,  tobacco,  late  at  night, 
will  sometimes  effectually  prevent  sleep  by  the  circu- 
latory disturbances  produced.  The  excitement  of 
digestive  activity,  or  the  disturbance  of  gastric 
function  caused  by  taking  a  full  meal  late  in  the 
day,  especially  in  persons  prone  to  dyspepsia,  is  also 
a  frequent  cau.se  of  iu.somnia.  Flatulent  distension 
of  the  stomach,  the  irritation  ,of  gastric  acidity,  the 
upward  pressure  on  the  heart,  and  the  palpitation 
thus  excited,  due  to  such  improper  habits  of  feeding. 


Chap.  X.]  Diet  IN  Epilepsy.  519 

give  rise  to  sleeplessness,  which  will  be  avoided  by 
adopting  different  habits. 

In  cases  of  chorea  some  attention  must  be  paid  to 
diet.  The  food  should  be  nutritious,  but  simple,  and 
such  as  can  be  easily  digested.  While  the  patient  is  -^ 
confined  to  bed  an  exclusive  milk  diet  may  be  appro- 
priate ;  and  if  milk  is  not  well  borne,  koumiss  has 
been  found  to  answer  well ;  but  a  mixed  diet  of  eggs, 
fish,  meat,  and  milk  is  often  well  tolerated.  Sweets 
must  be  avoided,  and  so  must  too  much  farinaceous 
food.  In  those  severe  cases  in  which  feeding  by  the 
mouth  is  difficult,  nutrient  enemata  must  be  given. 

Finally,  with  regard  to  epilepsy,  it  is  generally 
admitted  that  a  cai-eful  attention  to  diet  is  often 
attended  with  great  improvement  in  the  condition  of  • 
epileptics.  Epileptic  attacks  in  childhood  seem 
occasionally  due  to  errors  in  diet,  or,  at  any  rate,  to 
be  aggravated  by  them.  Epileptics  should  have 
nourishing  and  easily  digested  food,  limited,  however, 
strictly  to  the  quantity  necessary  for  nutrition ;  and 
all  sweets  should  be  avoided.  The  meat  should  be 
eaten  slowly,  and  the  food  well  masticated,  and  the 
chief  meal  should  be  in  the  middle  of  the  day. 
Most  authorities  consider  that  meat  should  not  be 
taken  more  than  once  a  day,  and  some  epileptic 
children  have  been  said  to  improve  rapidly  on  a 
strictly  vegetarian  diet,  consisting  of  milk,  bread, 
and  butter,  and  other  farinaceous  foods,  a  return  to 
a  meat  diet  being  followed  by  a  return  of  convulsions. 
It  has  also  been  noticed,  that  if  adult  epileptics  are 
given  a  diet  containing  much  meat,  they  become 
mentally  duller.  There  exists  a  tendency  in  epi- 
leptics to  gorge  themselves  with  food,  and  this  must 
be  carefully  guarded  against.  The  regular  use  of 
fresh  vegetables  and  fruits  is  advantageous,  especially 
as  it  tends  to  promote  free  action  of  the  bowels. 
Strong  tea  and  coffee,  as  well  as  all  alcoholic  drinks, 
should  be  avoided. 

In  the  epileptic  colony  at  Chalfont  St.  Peter  the 
following  is  the  daily  dietary  : — Breakfast :  oatmeal 


/ 

/ 


520  Food  in  Disease.  iPartii. 

porridge  with  new  milk  or  sugar,  tea,  unci  bread  and 
butter ;  Dinner :  roast,  or  boiled,  or  hashed  beef  or 
mutton,  witli  cabbages  and  potatoes,  followed  by 
rice,  sago,  tapioca,  suet,  or  jam-roll  pudding  ;  Tea, 
with  bread  and  butter  or  dripping,  and  sometimes 
golden  syrup,  or  currant  cake  ;  Supper  :  some  pudding, 
generally  with  milk  and  bread,  varied  occasionally 
with  soup  instead  of  pudding.  On  Fridays  fish  is 
given  instead  of  meat.  All  the  inmates  are  there 
engaged  for  a  number  of  hours  a  day  in  out-of-door 
work,  and  able,  therefore,  to  support  a  larger  diet 
than  if  without  active  muscular  work. 

It  has  been  said  that  an  animal  dietary  favours 
the  tendency,  where  it  exists,  to  the  development  of 
'  cancer,  just  as  it  promotes  gouty  manifestations  in 
those  who  are  constitutionally  predisposed  to  such 
maladies,  and  F.  W.  Beneke  introduced  a  special 
diet  for  the  treatment  of  cancer,  in  which  nitrogenous 
food  is  reduced  to  a  minimum.  This  dietary  is  her© 
given  : — 

Breakfast. 

Bread,  with  plenty  of  butter. 

Potatoes,  cooked  in  their  skins,  and  eaten  with  butter. 

A  strong  infusion  of  black  tea,  with  sugar  and  cream ;  or 
cocoa  may  be  substituted  for  tea. 

Lunch. 
Fruit,  raw  or  cooked. 

English  biscuits,  or  a  little  bread  and  butter, 
A  glass  of  wine. 

Dinner. 
Potato   soup,  or  fruit  soup,  or  wine   soup,   with  sago  or 

Indian  corn. 
Meat,  freshly  minced,  50  grammes  (rather  less  than  2  oz.). 
Potatoes,  mashed  ;  fricassee ;  in  puree ;  or  plain  boiled. 
Vegetable  roots  of  every  kind    (turnips,  parsnips,  carrots, 

etc.). 
Fruit,  stewed  (apples  or  plums,  with  rice  ;  or  lice  flavoured 

with  rum;. 
Salads  and  fruit  ices. 
Wines  (ligbt  lihenish,  or  Moselle,  or  Champagne). 

Afternoon  Tea. 
Black  tea,  with  sugar  and  cieam. 
A  little  bread  and  butter,  or  some  raw  fruit  and  biscuits. 


Chap.  X.]        BeiXekks  Diet  for  Cancer.  521 

Sin-KR. 
Soup,  as  at  dinner. 

Potatoes,  boiled  and  eaten  wilh  butter,  or  potato  salad. 
Sardines  in  oil,  anchovies,  or  fresh  herrings,  in  small  quan- 

tilics. 
Buckwheat  gi'uel,  with  wine  and  sugar. 
Light  wines. 

Beneke  maintained  that  by  means  of  this  diet  he 
I'educed  the  proportion  of  nitrogenous  to  non-niti'O- 
genous  aliment  from  1  to  5,  which  is  the  common 
one,  to  1  to  8  or  9.  Moreover,  there  will  be  a 
distinct  reduction  of  phosphates,  for  the  necessary 
salts  of  potash  will  be  taken  chiefly  in  combination 
with  the  vegetable  acids,  malic  and  tartaric ;  the 
urine  will  consequently  have  a  less  acid  reaction. 
He  restricted  the  consumption  of  cereals  and  pulses 
as  much  as  possible. 

It  has  been  questioned  whether  a  person  could 
subsist  on  a  diet  so  defective  in  albumen  and  phos- 
phates. Beneke  replied  that  he  had  proved,  by  piac- 
tical  experience,  that  it  was  possible,  and  that  persons 
so  treated  manifested  no  loss  of  strength  or  disturbance 
of  functions. 

It  must  be  noted,  however,  that  in  this  diet  for 
carcinomatous  patients,  the  predominance  of  vegetable 
foods  is  simply  designed  in  order  to  supply  the  least 
possible  amount  of  albumen  and  phosphoric  acid,  and 
is  not  founded  on  any  strict  vegetarian  principles  as  to 
the  source  of  the  foods,  whether  from  the  animal  or 
vegetable  kingdom  ;  regard  is  only  had  to  the  chemical 
composition  of  the  food. 

The  value  of  a  diet  in  which  as  little  albumen 
and  salts  of  phosphoric  acid  as  possible  are  introduced 
into  the  system  in  the  treatment  of  cancer  was  founded 
by  Beneke  on  the  following  considerations.  The  i)ro- 
toplasm  of  the  cells  consists  essentially  and  in  general 
of  water,  albumen,  cholesterin  and  lecithin,  with 
smaller  quantities  of  neutral  fats  and  fatty  acids, 
phosphates  of  potash  and  lime,  and  chlorides  of  the 
alkalies ;  that  these  constituents  exist  in  different 
cells  in  relatively  difi'erent  quantitative  proportion. 


52  2  Food  in  Disease.  [PartiL 

Beneke  believed  the  cells  of  carcinoma  to  be  relatively 
rich  in  cholesterin  and  in  lecithin,  and  since  cholesterin 
is  a  product  of  albuminates,  which  are,  again,  rich  in 
alkaline  and  earthy  phosphates,  he  concluded  that  the 
growth  of  the  tumours  in  question  may  be  checked 
by  the  use  of  a  diet  which,  while  just  answering  the 
needs  of  the  body  in  other  respects,  shall  contain  as 
little  as  possible  of  the  constituents  specially  required 
for  cell -formation — i.e.  cholesterin,  lecithin,  and 
earthy  and  alkaline  phosphates ;  and  with  this  object 
in  view  he  avoided  vegetable  as  well  as  animal  foods 
which  are  relatively  rich  in  these  substances,  and 
chose  those  vegetable  substances  in  which  the  carbo- 
hydrates largely  predominate. 


523 


CHAPTER    XI. 

CERTAIN  SPECIAL  DIETETIC  CURES. 

THE    "dry"    cure — MILK    AND    WHEY    CURES — THE 
KOUMISS   CURE — THE    GRAPE    CURE. 

In  Germany,  the  land  of  systematic  and  occasionally 
fantastic  "  cures,"  a  certain  John  Schroth  has  pro- 
mulgated a  "  dry  "  cure,  and  established  an  institution 
in  which  it  can  be  practised,  and  it  has  received  the 
notice  of  physicians  as  eminent  as  Bartels  and  Jiirg- 
ensen  —  an  attention  its  intrinsic  value  scarcely 
merited.  It  has  been  applied,  amongst  other  cases, 
to  the  cure  of  gastric  dilatation,  to  the  removal  of 
chronic  peritoneal  effusions  and  rheumatic  effusions 
into  joints,  and  to  cases  of  inA'eterate  syphilis. 

It  consists  in  gradually  depriving  the  patient  of 
fluid  to  an  extent  which  is  said  to  be  absolutely  in- 
tolerable in  many  instances,  causing  intense  suffering 
from  thirst,  and  exciting  in  most  cases  a  considerable 
amount  of  fever,  the  temperature  rising  as  high  as 
104°  F.  The  body  is  at  the  same  time  submitted  to 
warm,  moist  packing.  Fatal  cases  of  scurvy  have 
been  induced  by  this  treatment,  and  the  results 
obtained  have  been  by  no  means  brilliant ;  it  is  there- 
fore not  necessary  to  occupy  space  by  describing  it  in 
detail. 

There  are  undoubtedly  many  morbid  affections  in 
wliich  a  judicious  limitation  of  fluids  is  calculated  to 
be  advantageous,  and  in  which  a  diet  as  dry  as  can  be 
conveniently  tolerated  is  advisable. 

This  is  the  case  in  circulatory  distur])ances  with 
a  tendency  to  venous  engorgement  and  to  exudation 
into  the  serous  cavities  ;  in  cases  of  chronic  inflam- 
matory effusion  which  is  slow  to  disappear ;  in  gastric 


524  Food  in  Disease.  (Panii. 

dilatation  ;  in  cases  of  flatulent  dyspepsia  induced  by 
too  free  use  of  tea,  coffee,  and  other  beverages ;  and 
in  certain  cases  of  excessive  corpulence.  In  consider- 
ing the  dietetic  treatment  appropriate  to  the  last 
condition,  we  have  pointed  out  how  and  to  what 
extent  the  limitation  of  fluids  may  be  applied.  It 
must,  however,  be  borne  in  mind  that  in  gouty  cases, 
with  a  tendency  to  uratic  deposits,  a  deprivation  of 
water  is  calculated  to  do  harm. 

In  some  of  the  preceding  chapters  we  have  had 
occasion  to  dwell  at  some  length  on  the  application  of 
a  milk  diet  to  the  treatment  of  certain  morbid  states, 
and  it  will  be  unnecessary  to  repeat  here  what  has 
been  fully  considered  elsewhere.  But  the  so-called 
*'  ]?Iilk  cure  "  has  been  systematically  applied  to  the 
relief  of  many  other  ailments,  and  the  method  adopted 
we  shall  now  briefly  describe. 

Karell,  of  St.  Petersburg,  has  been  one  of  the 
chief  advocates  of  an  exclusively  milk  diet  in  certain 
diseases,  and  Weir  Mitchell  has  to  some  extent 
adopted  his  views  and  extended  their  application. 

In  connection  with  this  subject  Weir  Mitchell 
observes :  "  The  study  of  the  thei'apeutic  influence 
and  full  results  of  exclusive  diets  is  yet  to  be  made  ; 
nor  can  I  but  believe  that  accurate  dietetics  will  come 
to  be  a  far  more  useful  part  of  our  means  of  managing 
certain  cases  than  as  yet  seems  possible."* 

The  following  are  the  diseases  in  the  treatment  of 
which  an  exclusively  milk  diet  has  been  found  of 
value  : — Dropsies  of  all  kinds — cardiac,  renal,  and 
hepatic  ;  obstinate  intestinal  neuralgias  ;  incorrigible 
dyspepsias  with  grave  disturbances  of  nutrition ; 
chronic  colitis ;  hepatic  disorders,  such  as  hypersemia, 
simple  hy[)ertrophy,  and  fatty  liver  ;  asthma,  Avhen  the 
con.sequence  of  pulmonary  catarrh  and  emphysema; 
neurasthenic,  hysterical  and  hypochondriacal  states 
associated  with  serious  disturbances  of  nutrition ; 
and  especially  in  disorders  of  nutrition  dependent  on 
•  "  Fat  and  Dlood."    Fifth  edition,  1888. 


Chap.  XL]  The  '^  Milk  Cure."  525 

latent  catarrhs  of  the  stomach  and  intestine ;  also  in 
obesity. 

Karell  considers  the  methodical  application  of  the 
milk  cui'e  produces  its  curative  effects  by  acting  as 
a  regulator  of  nutrition  ;  and  he  maintains  that  it  is 
highly  beneficial  not  only  in  the  cases  already  enu- 
merated, but  also  in  rheumatic  and  gouty  affections, 
in  organic  diseases  of  the  heai-t  and  advanced  renal 
degeneration,  and  especially  in  degeneration  of  the 
arteries.* 

Both  Karell  and  Weir  Mitchell  direct  that  the 
milk  used  should  be  well  skimmed — as  creamless  as 
possible — and  it  should  be  obtained  fresh  twice  daily 
from  country-fed  cows.  They  also  agree  that  at  fii-st 
the  doses  should  be  small.  Weir  Mitchell  prescribes 
4  oz.  every  two  hours,  and  as  the  dose  is  increased 
the  interval  between  the  doses  is  lengthened  to  three 
hours ;  he  also  allows  a  glass  during  the  night  to 
which  a  little  lime-water  is  added  to  keep  it  sweet. 

Karell  commences  with  3  oz.  to  6  oz.  three  or 
four  times  a  day.  He  insists  on  the  doses  being 
rigorously  fixed  and  scrupulously  adhered  to,  and 
that  no  other  food  be  taken.  The  doses  should  be 
taken  at  equal  intervals,  and  drunk  slowly  in  small 
mouthfuls,  so  that  the  saliva  may  mix  with  it.  Taken 
in  this  way  it  will  be  readily  digested,  whereas  drunk 
ad  libitum  it  would  cause  indigestion.  In  winter  the 
milk  should  be  warmed  by  standing  the  glass  in  hot 
water ;  in  summer  it  should  be  of  the  temperature  of 
the  apartment.  It  should  not  be  boiled  except  in 
rare  cases  of  diarrhoea. 

If  the  milk  is  well  digested,  as  indicated  by  small 
solid  motions,  the  dose  is  slowly  increased.  The  first 
week  is  the  difficult  one  to  get  over ;  during  the 
second  week  two  litres  a  day  may  be  taken,  at  fixed 
intervals — viz.  8  a.m.,  12  noon,  4  p.m.,  and  8  p.m. 
These  hours  may  be  changed,  but  the  intervals  must 
be  maintained. 

When  there  is  great  objection  on  the  part  of 
*  "  Archives  G^ndrales  de  Medecine."    1866. 


526  JBooD  IN  Disease.  [Pan  11. 

the  patient  to  its  use,  with  nausea  or  disgust,  Weir 
Mitchell  allows  it  to  be  flavoured  with  a  little  tea, 
coffee,  caramel,  or  salt.  He  also  advises,  in  certain 
cases,  that  the  general  diet  should  be  displaced  slowly 
until  the  exclusive  milk  diet  can  be  tolerated.  When 
it  provokes  acidity  some  alkali  may  be  added,  such  as 
lime-water  or  Vichy  water  ;  or  it  may  be  scalded  with 
a  quarter  boiling  water  and  a  little  carbonate  of  soda, 
and  salt  added  ;  or  a  little  barley-  or  rice-water  may 
be  mixed  with  the  milk  to  prevent  firm  clotting,  as 
described  in  the  section  on  "  Food  in  Infancy." 

Karell  asserts  that,  although  he  commences  with 
such  small  doses,  the  patients  never  complain  of  either 
hunger  or  thirst ;  and  he  adds  that,  if  patients  whoai-e 
seriously  ill  attempt  to  take,  instead  of  the  four  cups  of 
skimmed  milk,  four  large  glasses  of  milk  direct  from 
the  cow,  they  will  certainly  not  be  able  to  digest  it, 
and  the  treatment  will  be  discredited.  In  obstinate 
sickness  and  diarrhoea  he  has  obtained  the  best  results 
from  these  small  doses,  and  he  cites  one  such  case  in 
which  he  gave  only  four  tablespoonfuls  of  skimmed 
milk  three  times  a  day.  No  doubt,  in  a  case  of  this 
kind,  the  almost  absolute  rest  of  the  digestive  organs 
which  such  treatment  aflFords  is  an  important  agent 
in  the  cure. 

Constipation  he  considers  a  natural  consequence 
and  a  good  sign — a  sign  that  the  milk  is  absorbed.  It 
may  be  remedied  by  a  simple  enema  of  water,  or  by 
a  small  dose  of  castor  oil  or  rhubarb  ;  and  if  obstinate 
a  little  coffee  should  be  mixed  with  the  morning  milk, 
or  some  stewed  prunes  or  a  baked  apple  may  be  eaten 
at  4  p.m. 

Flatulence  is,  as  a  rule,  completely  relieved  by 
this  diet;  if,  however,  any  flatulence  or  diarrhoea 
should  be  complained  of,  it  is  owing  either  to  im- 
perfect skimming  of  the  milk  or  to  its  being  taken 
in  too  large  a  quantity.  Thirst  may  be  relieved  by 
simple  water  or  seltzer  water. 

If  during  the  second  or  third  week  there  should 
be  a  great  desire  for  solid  food,  a  little  stale  bread 


Chap.  XL]  The  "Milk  Cure"  527 

with  salt,  or  a  small  portion  of  a  salted  herring,  is 
permitted ;  and  once  a  day  a  little  soup  made  with 
milk  and  thickened  with  groats.  After  five  or  six 
weeks  some  modification  is  admissible  ;  milk,  however, 
should  still  be  taken  three  times  a  day,  and  some 
other  suitable  food  at  dinner.  Weir  Mitchell  allows 
Nestle's  or  some  other  similar  food  to  be  substituted 
as  the  case  progresses.  To  objectors  Karell  says  : 
"Milk  is  a  food  easy  of  digestion  for  everybody, 
provided  it  is  given  with  precaution  in  strictly 
measured  doses  and  is  of  good  quality."  He  states 
that  he  has  obtained  excellent  results  in  desperate 
cases  where  other  remedies  had  proved  useless,  and 
especially  in  chronic  gastric  and  intestinal  disorders. 

Weir  Mitchell  points  out  the  importance  of  com- 
bining rest  with  this  treatment  at  the  commence- 
ment, as  the  patients  lose  weight  at  first  and  feel 
weak  on  account  of  the  small  amount  taken ;  after 
long  use,  however,  they  increase  in  weight.  For  the 
first  week  or  two  it  also  causes  sleepiness.  The 
tongue  becomes  covered  with  a  white,  thick  fur.  and 
the  patients  complain  of  an  unpleasant  sweetish  taste 
in  the  mouth  on  waking.  The  stools  are  of  a  yellowish 
colour,  and  have  a  peculiar  odour.  There  is  usually 
a  large  flow  of  urine  which  may  exceed  in  quantity 
the  fluid  ingested,  and  so  lead  to  the  removal  of  drop- 
sical eflfusions.  Weir  Mitchell  has  also  observed  that 
uric  acid  disappears  almost  entirely  from  the  urine, 
which  assumes  "  a  singular  greenish  tint,"  and  when 
hot  nitric  acid  is  poured  upon  it,  it  no  longer  gives 
the  usual  mahogany  tint  at  the  plane  of  contact ;  and 
it  would  seem  that,  during  a  diet  of  milk,  "the  ordi- 
nary pigments  of  the  urine  disappear,  or  are  singularly 
modified."  The  substances  which  give  rise  to  the 
ordinary  faecal  odours  also  disappear, 

'*  The  changes  here  pointed  out  are  remarkable 
indications  of  the  vast  alterations  in  assimilation,  and 
in  the  destruction   of  tissues  which   seems   to   take 
place  under  the  influence  of  this  peculiar  diet."  * 
*  "  Fat  and  Blood,"  p.  103,  5th  edition. 


528  Food  in  Disease.  [Panii. 

The  duration  of  the  cure  is  ordinarily  about  six 
weeks.  At  the  end  of  this  period  tlie  quantity  of 
milk  should  be  gradually  reduced  and  solid  food 
sluwly  inti'oduced  in  the  place  of  the  milk  meals. 
Karell  begins  with  raw  scraped  beef  and  stale  bread. 
But  for  several  months  the  diet  should  consist  largely 
of  milk. 

In  many  of  the  German  and  Swiss  Spas,  and  espe- 
cially in  those  with  alkaline  and  salt  springs,  where 
chronic  catarrh  of  the  respiratory  organs  is  treated, 
such  as  Ems,  Ischl,  Reichenhall,  etc.,  the  so-called 
*'"WIiey  cure"  is  applied.  This  consists  in  drinking 
warm  whey,  either  alone  or  mixed  with  the  mineral 
water,  in  definite  quantities,  at  set  times.  Many 
physicians  regard  this  practice  as,  in  all  respects, 
similar  to  the  use  of  skimmed  milk,  and  in  no 
respect  preferable  except  in  persons  who  find  the 
casein  of  milk  indigestible.  About  20  oz.  daily  are 
taken. 

It  relieves  irritable  laryngeal  coughs  and  exercises 
a  favourable  influence  over  chronic  laryngeal  and 
bronchial  catarrhs.  It  has  been  found  useful  in 
certain  forms  of  dyspepsia,  intestinal  catarrhs,  and  in 
chronic  phthisis.  It  acts  also  as  a  diuretic,  especially 
in  combination  with  the  saline  mineral  waters,  and 
recent  observations  have  shown  that  lactose  possesses 
distinctly  diuretic  properties.  It  has  been  recom- 
mended in  the  treatment  of  chronic  Bright's  disease. 

The  "whey  cure"  is  not  an  exclusive  diet  cure, 
but  it  is  usual  strictly  to  limit  the  quantity  of  animal 
food  taken,  and  to  augment  the  amount  of  fruit  and 
vegetables  ;  it  adds,  however,  to  the  diet  a  certain 
amount  of  milk-salts  and  milk-sugar.  There  are 
various  methods  of  preparing  whey,  and  these  have 
been  described  in  former  chapters.  Other  methods 
will  be  found  in  the  Appendix.  At  the  healtli- 
resorts  mentioned,  whey  is  prepared  from  the  milk 
of  the  sheep  and  the  goat,  as  well  as  from  cow's 
milk. 


Chap.  XL]  The  Koumiss  Cure.  529 

Kouiuiss,  the  fermented  milk  of  the  Steppe 
mares,  which  is  used  as  a  food  and  as  an  intoxicating 
beverage  by  all  the  nomadic  tribes  of  the  South- 
Eastern  Steppe  country  of  Russia,  has  been  already 
referred  to  in  previous  chapters. 

It  is  as  a  systematic  cure  in  various  maladies  that 
we  now  refer  to  it  again.  It  is  in  the  Steppes  them- 
selves that  the  best  koumiss  and  the  best  results  of 
the  koumiss  treatment  are  obtained,  although  at 
Moscow  and  St.  Petersburg  institutions  exist. for  the 
application  of  this  cure,  where  koumiss  prepared 
from  Steppe  mares  is  employed.  A  specially  selected 
breed  of  mares  yield  the  milk  made  use  of.  The 
summer  climate  of  the  Steppes  seems  to  be  especially 
favourable  to  the  treatment  of  pulmonary  complaints, 
but  the  winters  are  extremely  severe.  The  nomads 
appear  to  possess  the  art  of  making  koumiss  in  the 
greatest  perfection ;  but  its  composition  is  by  no 
means  stable.  It  is  comparatively  rich  in  sugar,  and 
poor  in  casein  and  fat. 

Large  quantities  of  koumiss  can  be  easily  digested, 
and  it  has  been  observed  to  exert  a  diaphoretic  or  a 
diuretic  action,  according  as  the  external  temperature 
is  high  or  low.  Its  use  is  constantly  attended  by  a 
gain  in  weight. 

Many  cases  of  phthisis  are  reported  to  have  been 
cured  by  this  treatment  when  followed  in  the  Steppes 
of  Orenberg  or  Ssamara,  where  doubtless  the  dry 
climate  has  also  a  curative  influence. 

The  best  koumiss  is  made  from  the  milk  of  light- 
coloured  unbroken  mares,  pasturing  in  the  Steppes, 
near  mountain  ranges,  where  they  can  get  running 
water  and  salt-beds.  They  should  be  able  to  bathe 
frequently,  and  they  must  not  have  either  hay  or 
oats. 

There  are  two  kinds  prepared,  one  light  and  slightly 
fermented,  the  other  strong  and  highly  fermented. 

The  patients  are  made  to  rise  early  and  take  a 
glass  of  koumiss  every  half-hour,  except  during  the 
two  hours  preceding  dinner  and  supper.  Meat  and 
II 


530  Food  in  Disease.  [Partii. 

fats  form  the  chief  part  of  the  ordinary  food  ;  sweets, 
fruit,  and  salads  are  avoided,  as  well  as  ices,  coffee, 
and  spii-its. 

Lime-water  is  used  to  arrest  the  diarrhoea  koumiss 
often  causes.  At  first  a  few  glasses  only  are  taken 
daily,  so  as  to  accustom  the  patient  gradually  to 
the  cure. 

Most  invalids  digest  it  well ;  it  relieves  constipa- 
tion and  acts  as  a  diuretic.  They  gain  in  weight  and 
show  signs  of  increased  blood-formation.  Tent-life 
and  much  exercise  in  the  open  air  are,  no  doubt,  im- 
portant adjuncts  to  the  cure. 

We  have  already  mentioned,  in  a  former  chapter, 
Annaeff's  and  Postnikoft's  establishments  at  Ssamara, 
as  the  best  places  for  following  this  cure. 

Good  koumiss  is  a  milky-looking,  frothy  liquid, 
with  an  agreeable,  slightly  acid  taste.  It  contains 
about  1  per  cent  of  alcohol  and  lactic  acid.  Its  ready 
digestibility  has  been  referred  to  the  alcohol  in  it 
stimulating  the  digestive  secretions,  and  the  carbonic 
acid  allaying  gastric  irritability. 

The  proportion  of  alcohol  in  koumiss  is  too  small 
to  produce  any  symptoms  of  intoxication  ;  but  a  tend- 
ency to  sleep  and  to  mental  and  bodily  languor  has 
been  noticed  to  follow  its  use.  Excitement  of  the 
sexual  organs  has  also  been  noted  by  several  observers 
to  follow  the  use  of  koumiss. 

The  treatment  in  the  Stepi)es  lasts  two  or  three 
months,  and  is  often  renewed  the  following  summer. 

Annaeffs  establishment  stands  in  a  pai'k  on  a  hill 
on  the  banks  of  the  Volga,  three  versts  distant  from 
Ssamara.  It  is  provided  with  a  library,  theatre,  and 
other  comforts.  The  koumiss  is  prepared  by  a  Tartar 
family  in  the  sight  of  the  patients,  and  with  due 
regard  to  cleanliness.  In  its  manufacture  the  milk- 
sugar  is  converted  into  alcohol,  carbonic  acid,  and 
lactic  acid.  The  casein  is  in  a  state  of  fine  subdivision 
most  easy  of  digestion.  Dr.  Stange,  of  St.  Petei-s- 
burg,  who  studied  the  koumiss  cure  in  Annaefl's 
establishment,  gives  the  following  : — 


Chap.  Xl.J 


The  Koumiss  Cure. 


531 


Table  op  thb  Eklativb  Composition  of  the  SEviikAL 
Strengths  of  Koumiss. 


Koumiss— Duration  of  Fermentation. 

Male's 
Milk. 

6  hours. 

18  hours. 

£0  hours. 

4  days. 

Carbonic  Acid    . 

3-8 

6-0 

70 

11-0 

Alcohol 



185 

19-5 

30-0 

30-0 

Lactic  Acid 



39 

5-6 

6-4 

6-4 

Wilk-3ugar 

51 

18-8 

16-3 

— 

Albumen    . 

23 

22-5 

22-6 

200 

16-0 

Fat     . 

19 

18-9 

20-0 

19-0 

190 

Salts  . 

5 

4-5 

40 

40 

4-0 

An  analysis  of  koumiss,  made  in  Moscow  after 
two  days'  fermentation,  gave  alcohol,  1'65  per  cent.  ; 
fat,  2-05;  milk-sugar,  2-20;  lactic  acid,  1-15;  finely 
divided  casein,  1*12  ;  salts,  0'28  ;  carbonic  acid,  0'70. 
Dr.  Stange  came  to  the  conclusion  that  "  favourable 
results  can  only  be  obtained  from  the  koumiss  cure 
in  the  Steppes,  since,  besides  the  employment  of  a 
genuine  koumiss,  a  hot  and  dry  climate  is  absolutely 
necessary ;  "  that  it  is  especially  beneficial  in  catarrhal 
conditions  of  the  respiratory  and  gastric  mucous 
membrane ;  that  it  is  often  successful  in  the  fii-st 
stage  of  phthisis,  in  the  second  stage  it  simply  im- 
proves the  general  condition,  in  the  third  stage  it  is 
badly  borne  ;  that  it  is  especially  curative  in  cases 
of  defective  nutrition  generally — cases  of  anaemia, 
chlorosis,  malarial  cachexia,  scrofula,  etc. 

Artificial  koumiss  is  prepared  in  England  by  the 
Aylesbury  and  other  dairy  companies. 

The  koumiss  cure  has  been  well  and  briefly  defined 
as  "  essentially  nothing  more  than  a  high  nutrition  of 
the  sick."  * 

The  grape  cure  is  another  dietetic  cure  of  which 
a  brief  account  must  here  be  given. 

*  Bauer,  "  Dietary  of  the  Sick,"  p.  357. 
ii2 


532  Food  in  Disease.  [Partii. 

The  nutritive  value  of  grapes  is  not  great ;  they, 
however,  contain  much  sugar  as  well  as  potash  salts. 
They  are  an  agi-ceable  form  of  food,  and  afford  one 
of  the  few  means  at  our  disposal  between  nutritive 
substances  on  the  one  hand  and  medicinal  substances 
on  the  other.  Much  of  the  benefit  referred  to  this 
cure  may  doubtless  be  attributable  to  the  climatic 
advantages  })resented  by  those  agreeable  localities, 
such  as  Meran  and  Montreux,  where  it  is  usually 
followed. 

Professor  Leber t  speaks  of  the  grape  cure  as 
essentially  a  dietetic  cure,  notwithstanding  its  re- 
freshing and  aperient  effects  ;  and  he  is  quite  opposed 
to  the  consumption  of  very  large  quantities,  as  has 
been  advised  by  some  authorities,  and  considers  that 
only  moderate  quantities  should  be  prescribed.  The 
effect  of  the  cure  is  aided  by  a  good  supporting  diet. 
Pulmonary  patients  should  not  take  more  than  an 
average  of  2  lb.  daily,  beginning  with  about  a  pound; 
and  other  patients  should  not  exceed  4  lb.  In  cases 
of  gastric  catarrh  3  lb.  a  day  may  be  eaten,  the  diet 
at  the  same  time  being  carefully  regiilated.  Consti- 
pation, with  hepatic  congestion  and  "abdominal 
plethora,"  may  be  benefited  by  3  lb.  to  4  lb.  daily ; 
and  in  these  cases  the  dose  may,  exceptionally,  be 
increased  to  5  or  6  lb.  The  laxative  influence  of 
4  lb.  to  6  lb.  of  grapes  eaten  daily  has  been  found 
beneficial  in  haeraorrhoidal  affections  and  in  cardiac 
diseases  with  a  tendency  to  visceral  congestion  and 
venous  engorgement,  in  hypersemia  of  the  liver  and 
in  chronic  constipation. 

The  tendency  to  renal  and  hepatic  concretions  is 
often  advantageously  modified  by  this  cure.  Professor 
Lebert  remarks,  as  the  result  of  his  own  observations 
at  Montreux,  that  the  grape  cure  is  very  valuable 
"  to  those  who  are  neither  ill  nor  well,  who  are 
fatigued  by  a  too  exciting  and  somewhat  intemperate 
life  ;  or,  weakened  by  severe  illnesses,  are  convalescing 
slowly ;  or  who,  leading  habitually  a  too  sedentary 
and   too   laborious   existence,    find   in   our   country, 


Chap.  XL]  Thr  Grape  Cure.  533 

besides  the  grapes,  which  regulate  the  digestive 
functions,  all  those  hygienic  conditions  which  they 
most  need.  In  this  way  the  passage  of  debility  and 
fatigue  into  real  diseases  may  often  be  prevented.' 
It  is  best  to  begin  with  half  a  pound  of  grapes  in  the 
morning  fasting  (or  an  hour  or  two  after  a  light 
breakfast  if  they  disagree  when  taken  fasting)  and 
another  half  a  pound  at  5  p.m.  After  two  or  three 
days  a  third  half  a  pound  should  be  taken  between 
1 1  and  1 2  noon.  Little  by  little  the  dose  is  increased 
to  about  a  pound  each  time.  In  cases  of  chest  disease 
Lebert  rarely  exceeded  the  smaller  quantity.  In  other 
cases  which  bear  the  cure  well  larger  quantities  may  be 
prescribed.  In  some  cases  of  dyspepsia  a  bunch  or 
two  at  dessert  may  be  substituted  for  the  midday  dose. 

The  aperient  effect  may  not  be  manifest  at  fii'st, 
but  it  usually  shows  itself  after  a  few  days. 

Figs  and  pears  are  also  permitted  with  the  cure  at 
Meran  in  order  to  diminish  the  repugnance  to  one 
kind  of  fruit  alone. 

Some  irritation  of  the  gums  is  apt  to  be  excited 
during  the  cure  ;  this  may  be  relieved  by  rinsing  the 
mouth  with  cold  water,  to  which  a  little  bicarbonate 
of  soda  is  added.  It  has  also  been  recommended  that 
the  patient  should,  while  eating  the  grapes,  take  from 
time  to  time  a  small  piece  of  fine  white  bread  to 
remove  the  acid  adhering  to  the  teeth. 

Towards  the  end  of  the  cure,  which  lasts  from 
four  to  six  weeks,  the  quantity  of  grapes  should  be 
gradually  diminished. 

The  mean  composition  of  grapes,  according  to 
Konig,  is — water,  78-17  per  cent.  ;  sugar,  14'36  ;  free 
acid,  0'79 ;  nitrogenous  substances,  0-59  ;  non-nitro- 
genous extractives,  1  -96  ;  stones  and  woody  fibre, 
3'60 ;  total  ash,  0-53.  The  ash  consists  chiefly  of 
potash  salts,  together  with  salts  of  lime  and  mag- 
nesia. 

We  have  already  indicated  certain  cases  in  which 
the  grape  cure  may  prove  beneficial.  It  is  also  pre- 
scribed with  success  in   those   cases  of   "  abdominal 


534  Food  in  Disease.  [Partii.* 

plethora  "  associated  with  a  deposition  of  much  super- 
fluous fiit ;  much  of  this  fat  may  be  removed  if  the 
laxative  influence  of  the  grapes  is  aided  by  a  spare 
diet  in  which  the  fats  and  carbohydrates  are  strictly 
limited.  It  cannot  be  credited  with  any  real  curative 
influence  in  phthisis,  but  it  appears  to  be  useful  in 
cases  of  chronic  bronchial  catarrh  and  emphysema; 
and  it  may  no  doubt  relieve  the  bronchial  catarrh 
which  accompanies  most  cases  of  phthisis. 

It  has  been  found  beneflcial  in  cases  of  gastric  and 
intestinal  catarrh  in  anaemic  persons,  in  vesical 
catarrh,  in  gouty  concretions,  and  in  cases  of  malarial 
cachexia. 


535 


CHAPTER    XII. 

ON   ARTIFICIAL    DIGESTIVE    AGENTS    AND    ON    ARTIFICIAL 
ALIMENTATION. 

One  of  the  most  remarkable  developments  of  modern 
therapeutics,  and  one  which  has  rendered  great  service 
in  the  treatment  of  many  troublesome  maladies  in 
which  the  functions  of  the  various  organs  of  digestion 
and  assimilation  have  been  directly  or  indirectly  im- 
paired, has  been  the  artificial  preparation,  out  of  the 
body,  of  the  several  digestive  ferments,  or  active 
agents  of  the  digestive  secretions,  by  means  of  which 
it  has  been  possible  either  to  administer  pre-digested 
food,  i.e.  food  ready  for  immediate  absorption  into 
the  cii'culating  fluids,  or  to  aid  digestion  by  supplying 
ivith  the  food  the  deficient  digestive  ferments. 

The  utility  of  these  expedients  in  the  dietetic 
management  of  many  morbid  states  has  been  alluded 
to  in  some  of  the  preceding  chapters. 

The  amylolytic  ferment  of  the  saliva  can  be  I'e- 
placed  by  the  diastase  of  malt,  which  possesses  the 
property  of  converting  starches  into  dextrin  and 
maltose,  and  this  pi'operty  of  malt  is  largely  utilised, 
either  in  the  administration  of  the  various  "I^lalt 
Extracts,^'  or  by  the  addition  of  the  meal  of  malt  to 
other  farinaceous  foods. 

The  pepsin  of  the  gastric  juice,  obtained  from  the 
gastric  glands  themselves  of  certain  animals,  was  the 
earliest  employed  of  all  the  digestive  ferments,  and  it 
is  now  largely  given  to  increase  the  activity  of  gastric 
digestion  when  impaired,  and  to  promote  the  solution 
and  peptonisation  of  the  albuminates  in  the  stomach. 

But  the  most  extensively  used  of  all  these  ferments 
is  that  extracted  from  the  pancreas,  for  this  has  a 
far  wider-reaching  digestive  action  than  either  of  the 


536  Food  in  Disease.  [Pan  11. 

others,  as  it  not  only  digests  nitrogenous  foods  and 
converts  albuminates  into  peptones,  but  it  has  the 
power  of  converting  starch  into  dextrin  and  sugar, 
and  it  further  possesses  the  proi)erty  of  emulsifying 
fats  ;  so  that  nearly  all  the  pre-digested  or  partially 
pre-digested  foods — i.e.  all  the  peptonised  foods — now 
in  use  are  peptonised  by  the  addition  of  the  pancreatic 
ferments. 

We  propose  to  examine  briefly  the  properties  and 
uses  of  each  of  these  three  artificial  digestive  agents. 

An  objection,  it  seems  to  us,  of  a  somewhat 
singular  character  has  been  made  to  the  employment 
of  pre-digested  foods,  viz.  that  they  usurp  the  gastric 
and  duodenal  functions,  and  that  their  use  is  demoral- 
ising (!)  to  the  healthy  stomach.  No  one  dreams  of 
objecting  to  crutches  on  the  ground  that  they  are  de- 
moralising to  those  who  are  not  lame,  because  no  one 
imagines  they  will  ever  be  ordered  for  persons  with 
sound  limbs.  So  with  these  artificial  digestive  agents — 
they  are  intended  and  devised  for  the  sick,  and  not  for 
the  sound ;  for  the  abnormal  stomach,  not  the  normal 
one  ;  to  supply  what  is  defective,  not  to  add  to  what 
is  already  abundant,  and  it  is  a  perfectly  gratuitous 
objection  to  assert  that  they  are  demoi-alising  in 
certain  healthy  conditions,  in  which  it  was  never  in- 
tended they  should  be  used !  No  valid  objection, 
that  we  are  aware  of,  has  been  made  to  their  use  in 
those  disorders  of  the  digestive  functions  for  which 
they  are  e.specially  appropriate. 

And  first,  with  regard  to  the  use  of  Malt 
extracts  and  Malted  food  in  general.  It  must  be 
borne  in  mind  that  these  are  simply  pre-digested 
starches,  together  with  other  nutritive  substances,  and 
it  must  not  be  concluded  that  they  can  supplement 
or  reinforce  the  pancreatic  digestion  of  starch  in  the 
small  intestine,  for  the  amylolytic  ferments  are  wholly 
inactive  in  the  presence  of  free  acid,  and  the  salivary 
(diastasic)  ferment  is  under  ordinary  conditions  de- 
stroyed in  the  stomach.  The  diastase  of  malt,  like 
the  salivary  ferment,  exei-ts  its  amylolytic  action  most 


Chap.  XII.]  Malt  Extracts.  537 

energetically  in  a  neutral  fluid  ;  the  addition  of  an 
alkaline  carbonate  retards  it,  while  a  very  slight 
amount  of  acid  (such  as  the  hydrochloric  acid  of  the 
gastric  juice)  puts  a  stop  to  it.  In  the  feeding  of 
very  young  infants  who  cannot  digest  milk,  and  who, 
as  we  have  seen,  naturally  lack  the  salivary  and 
pancreatic  secretions,  when  malted  foods  are  used  it 
is  for  the  purpose  of  supplying  pre-digested  starch, 
which  they  are  unable  to  digest  from  the  lack  of 
these  fei'ments.  It  is  possible  that  we  might  in  older 
subjects  convey  the  diastasic  ferment  safely  through 
the  stomach  into  the  small  intestine,  if  we  desired  to, 
by  previously  neutralising  the  acid  of  the  stomach  by 
giving  a  little  carbonate  of  lime  or  magnesia  ;  but  we 
should  then  be  interfering  with  the  action  of  one 
digestive  ferment  in  order  to  reinforce  that  of  another. 

The  diastasic  power  of  malt  extracts  has  been 
found  inferior  to  that  of  ground  malt  itself,  and  these, 
as  we  have  said,  must  be  regai'ded  rather  as  prepara- 
tions of  soluble  foods  than  as  digestive  agents.  They 
contain,  besides  the  diastase  of  thp  malt  and  pre- 
digested  starch  (dextrin  and  maltose),  some  of  the 
albuminates  and  salts  of  the  barley.  Like  ground 
malt,  when  added  to  farinaceous  foods  and  kept  at  a 
temperature  below  150°  F.,  they  promote  the  trans- 
formation of  the  starches  into  dextrin  and  sugar  ; 
but  it  is  an  error,  as  we  have  just  pointed  out,  to 
suppose  that  they  continue  this  amylolytic  action 
when  taken  into  the  stomach. 

Many  varieties  of  "  malted  foods "  are  now  in 
common  use,  but  "  Liebig's  Infant's  Food "  may  be 
taken  as  the  prototype  of  all  these.  It  contains 
ground  malt,  wheat  flour,  pota.ssium  bicai'bonate,  and 
milk,  and  it  is  directed  to  be  made  in  the  following 
manner : — 

Mix  well  \  an  ounce  of  ground  malt,  with  \  an 
ounce  of  wheat  flour,  and  7:^  grains  of  potas.sium 
bicarbonate  ;  add  1  ounce  of  water,  and  5  ounces  of 
fresh  cow's  milk.  Warm  over  a  slow  fire,  and  keep 
stirring  until  it  gets  thick.     Remove  from  fire,  stir 


538  Food  in  Disease.  [Panii. 

five  minutes,  replace  it  on  the  fire,  and  again  remove 
it  as  soon  as  it  gets  thick.  As  the  starch  gets  con- 
verted into  dextrin  and  sugar  by  the  diastase  of  the 
malt  it  will  become  a  thin  and  sweet  liquid.  Then 
finally  boil  it  well.     Strain  through  muslin. 

This  food  is  highly  nutritious ;  besides  the  con- 
stituents of  the  milk,  it  contains  pre-digested  starch 
(dextrin  and  maltose)  and  the  albuminates  (gluten  and 
albumen)  of  the  wheat  fiour  and  of  the  malted  barley. 

Foods  composed  (as  some  malted  foods  are)  of 
malted  flour  and  desiccated  milk,  when  mixed  with 
water,  are  defective  as  the  sole  food  for  children,  as 
they  do  not  contain  the  adequate  proportions  of  fats, 
proteids,  and  salts ;  but  these  can  be  readily  in- 
creased by  the  addition  of  a  little  cream,  or  rich  milk, 
or  some  raw  meat  juice.  In  preparing  the  various 
malted  foods  it  is  usual  to  bake  the  wheat  flour,  so  as 
to  render  the  starch  granules  more  soluble. 

Mellin's,  Nestl^'s,  Savory  and  Moore's,  Allen  and 
Hanbuiys'  infant  foods  are  examples  of  these  malted 
preparations.  The  two  latter  are  not  completely  pre- 
digested,  so  that  something  is  left  to  exercise  the 
child's  digestive  organs ;  and  Savory  and  Moore  use 
"  whole  wheat  meal,"  and  their  food,  therefore,  con- 
tains more  of  the  nutrient  constituents  of  the  grain. 

Pepsin,  the  proteolytic  ferment  of  the  gastric 
juice,  acts  only  when  in  combination  with  an  acid, 
and  preferably  hydrochloric  acid.  In  contact  with  a 
dilute  solution  of  sodium  carbonate,  at  the  temperature 
of  the  body,  it  is  quickly  destroyed,  and  it  is  also 
quickly  destroyed  by  tlie  alkaline  secretions  of  the 
small  intestine,  aided  by  the  action  of  the  pancreatic 
ferment,  trypsin. 

Pepsin  is  rarely  used  for  the  preparation  of  arti- 
ficial peptones  or  pre-digested  foods,  but  it  is  largely 
given  to  promote  the  activity  of  stomach  digestion  in 
the  stomach  itself. 

For  this  purpose  many  excellent  preparations 
exist,  but  some  are  very  xmcertain,  and  many  pro- 
bably quite  inert 


Chap. xii.i         Pancreatic  Extracts.  539 

Professor  Chittenden,  of  Yale  University,  found 
the  following  remarkable  differences  in  the  proteolytic 
power  of  different  pepsins*  : — 

Relative 

proteolytic 

action. 

1.  Parke  Davis  and  Co.'s  Pepsinum  Purum  in  lamellis  1 00 

2.  Fiiirchild's  Pepsin  in  Scales   .         .         .         .         .52 

3.  Scheffer's  Dry  Pepsin  Concentrated        .         .         .48 

4.  Jensen's  Crystal  Pepsin 35 

6.  Boiidault's  Pepsin 14 

6.  Royal  Chemical  Company's  Pure  Pepsin        .         .      9 

In  England  there  are   especially  reliable  pepsin 
preparations  in  Benger's  liquor  peptinis  and  Bullock's 
acid  glycerine  of  pepsin ;  and  Burroughs  and  Well- 
come supply  Fairchild's   "  pepsin  in  scales "  in  the  • 
form  of  convenient  tabloids. 

Thirdly,  we  come  to  the  pancreatic  extracts 
and  peptonised  foods,  in  the  preparation  of  which 
pancreatic  extracts  play  the  principal  parts. 

We  have  already,  in  a  former  chapter  (page  140), 
estimated  the  value  of  peptones  in  nutrition,  and  con- 
sidered to  what  extent  they  can  replace  albuminates. 

We  must  again  point  out  that  the  value  of  those 
preparations  depends  on  their  being  pre-c?t^esfec?  foods, 
and  it  would  be  an  error  to  suppose  that  in  adminis- 
tering them  we  are  introducing  an  active  digestive 
ferment  into  the  small  intestine ;  for  the  proteolytic 
action  of  trypsin  is  arrested  in  an  acid  medium  like 
the  gastric  juice,  and  the  gastric  pepsin  aids  in  the 
destruction  of  the  ferment.  "  Hence,  it  is  obvious 
that  pancreatic  extracts  or  ferments  given .  by  the 
mouth  can  be  of  no  value  whatever,  since  the  proteo- 
lytic ferment,  at  least,  will  undoubtedly  be  destroyed 
in  the  stomach  before  reaching  its  normal  sphere  of 
action."  f 

If,  however,  as  seems  possible,  the  pancreatic  ex- 
tracts could  be  administered   in   capsules   composed 

*  Philadelphia  Medical  News,  Feb.  16,  1889. 
+  Prof.    Chittenden  on  "Digestive  Ferments,"    Philadelphia 
Medical  News,  Feb.  16,  1889. 


54°  Food  in  Disease.  [Part  ii. 

of  a  substance  insoluble  in  dilute  acid,  but  soluble  in 
alkaline  fluids,  and  be  so  conveyed  through  the 
stomach  harmless  to  the  duodenum,  the  difficulty 
would  be  overcome.  [Keratin  appears  to  be  a  sub- 
stance of  this  kind.) 

Trypsin  acts  best  in  an  alkaline  medium,  and 
pancreatic  extracts  are  usually  mixed  with  an  alkali ; 
but  it  is  also  active  in  a  neutral  medium. 

Peptonised  foods,  strictly  speaking,  are  artificially 
digested  albuminates,  and  might  be  made  with  pepsin 
and  hydrochloric  acid,  as  well  as  with  pancreatic 
extract ;  but  the  latter  is  generally  used,  and  when 
applied  to  foods  containing  carbohydrates,  or  fats,  as 
well  as  albuminates,  its  amylolyLic  and  emulsifying 
properties  also  come  into  operation,  and  we  obtain  a 
very  completely  pre-digested  food. 

Pancreatin  and  the  pancreatic  peptones  decom- 
pose very  readily,  and  for  this  reason  it  is  important 
in  using  them  to  be  careful  that  no  poisonous  fer- 
ments are  thereby  introduced  into  the  organism. 

Meat  peptones  are,  no  doubt,  highly  nutritious, 
but  they  are  often  of  an  unpleasant  taste  and  odour  : 
the  smell  of  pure  muscle  peptone  is  stated  by  Zuntz 
to  be  very  objectionable,  and  the  more  agreeably 
flavoured  preparations  were  said  by  Dujardin-Beau- 
raetz  to  contain  much  comparatively  useless  gelatin- 
peptone. 

The  unpleasant  odour  and  taste  detract  un- 
doubtedly from  the  administration  of  meat  peptones 
by  the  mouth,  but  it  does  not  interfere  with  their 
employment  in  rectal  alimentation,  for  which  they 
are,  as  we  shall  presently  see,  very  valuable. 

Benger's  peptonised  beef -jelly  (partially  digested 
and  solidified  beef- tea),  and  chicken  jelly  are,  however, 
pleasantly  flavoured  foods,  and  agreeable  to  patients 
generally.  Savory  and  Moore's  beef  peptone  is  also 
said  to  be  of  not  unpleasant  flavour. 

There  are  many  meat  peptones  in  the  market,  the 
best  known  being  Koch's,  Kemmerich's,  Catillon's, 
and  Camick's. 


Chap.  XII.]  Peptonised  Foods.  54 1 

There  are  also  many  pancreatised  foods,  containing 
other  pre  digested  substances  besides  peptones  ;  these 
are  veiy  useful  in  states  of  depressed  nutrition  with 
loss  of  digestive  power.  "  Benger's  Food  "  is  one  of 
the  best  of  these ;  it  is  prepared  with  cooked  wheat- 
meal  and  pancreatic  extract ;  mixed  with  warm  milk 
or  milk  and  water,  it  acts  on  starches  like  malt 
diastase,  and  renders  the  casein  more  digestible.  In 
the  same  manner  pancreatised  oat  flour  and  lentil 
flour  are  ])repared  by  Beiiger. 

"  Carnick's  Soluble  Infant's  Food  "  is  made  with 
l)artially  peptonised  milk,  by  means  of  pancreatin, 
together  with  wheat  flour  and  some  added  lactose. 

Concentrated  peptonised  milk,  cocoa  and  milk, 
and  coSee  and  milk  are  prepared  by  Savory  and 
Moore,  and  are  agreeable  and  valuable  preparations. 

Loeflund's  peptonised  kindermilch  is  also  a  good 
food. 

But  many  peptonised  foods  can  be  conveniently 
made  for  the  sick-room,  as  required,  by  means  of  pan- 
creatic extracts  now  readily  obtainable. 

The  best  of  these  are  Benger's  liquor  pancreaticus, 
Benger's  peptonising  powders,  and  Fairchild's  zymine, 
a  very  convenient  and  active  pancreatic  extract,  in- 
troduced by  Messrs.  Burroughs  and  Wellcome,  and 
supplied  in  air-tight  glass  tubes,  each  containing  the 
exact  quantity  of  panci'eatic  extract  (5  grains),  and 
sodium  bicarbonate  (15  grains)  i-equired  to  peplonise 
one  pint  of  milk.  These  pancreatin  powders  are 
very  hygroscopic,  and  it  is  important  that  they  should 
be  kept  in  air-tight  glass  tubes  such  as  these. 

Milk  can  readily  be  peptonised  by  these  pancreatic 
extracts,  the  casein  is  converted  into  soluble  peptones, 
and  it  thus  becomes  a  most  valuable  food  for  delicate 
infants  and  others  who  cannot  digest  the  coagulated 
casein  of  cow's  milk.  If,  however,  the  milk  be  com- 
pletely peptonised,  it  acquires  a  bitter  taste  which 
reuders  it  unpleasant,  and  children  will  object  to  take 
it;  but  if,  as  we  shall  describe,  the  process  of  pepton- 
isation  be  ancsted  at  the  proper  time,  and  the  milk 


542  Food  in  Disease.  [Part  ii. 

be  only  partially  peptonised  (which,  for  other  reasons, 
is  an  advantage),  no  disagreeable  bitter  taste  is  de- 
veloped. 

The  method  of  peptonising  milk  by  means  of  Fair- 
child's  peptonising  powders  is  very  simple. 

Into  a  clean  quart  bottle  pour  a  pint  of  milk,  add 
a  quarter  of  a  pint  of  water,  and  a  tube  of  Fairchild's 
powder ;  shake  them  together.  Put  the  bottle  into 
water  as  hot  as  the  hand  can  bear  (about  150°  F.),  and 
let  it  stand  for  half  an  hour ;  then  boil  for  two  or  three 
minutes.  It  is  then  ready  for  use.  It  should  be  kept 
in  ice,  or  freshly  made  for  each  feeding.  Boiling  is 
for  the  purpose  of  permanently  arresting  the  action  of 
the  ferment ;  cold  will  arrest  it  temporarily,  and  if 
kept  covered  with  ice  it  is  not  necessary  to  boil  it. 

If  the  milk  be  allowed  to  stand  longer  than  half 
an  hour,  peptonisation  will  proceed  too  far,  and  un- 
desirable bitter  products  will  be  generated. 

We  can  regulate  the  peptonisation  to  any  degree 
required,  and  we  should  be  guided  l:)y  the  readiness 
with  which  the  food  is  assimilated  by  the  patient. 
For  young  bottle-fed  infants  a  very  slight  degree  of 
peptonisation  is  often  all  that  is  required. 

A  teaspoonful  or  two  of  Benger's  liquor  pancre- 
aticus  and  15  grains  of  bicaibonate  of  soda  will 
answer  equally  well.  The  more  completely  we  desire 
the  food  to  be  peptonised,  the  more,  proportionately, 
of  the  digestive  agent  should  be  employed,  and  the 
longer  should  the  process  be  allowed  to  continue. 

Peptonised  milk  gruel  is  also  an  excellent  and 
valuable  pre-digested  food,  highly  commended  by  Sir 
W.  Roberts.  It  can  be  made  as  follows  :  — A  good 
thick  gruel  made  with  oatmeal  or  other  meal,  while 
still  boiling  hot,  is  added  to  an  equal  quantity  of  cold 
milk.  The  temperature  of  the  mixture  will  then  be 
about  140°  F.  To  a  pint  of  this  mixture  two  or 
three  teaspoonfuls  of  liquor  pancreaticus  and  twenty 
grains  of  bicarbonate  of  soda  are  added.  It  is  kept 
at  the  same  temperature  for  about  two  hours,  and 
then  boiled  for  a  few  minutes  and  strained. 


Chap.  XII.]  Peptonised  Foods.  543 

In  this  mixture  not  only  is  the  casein  of  the  milk 
peptonised,  but  the  starch  of  the  meal  is  converted 
into  sugar,  and  its  albuminates  are  peptonised. 

The  bitterness  of  the  pre-digested  milk  is  scarcely 
perceptible  in  this  gruel. 

Lean  meat  can  also  be  readily  peptonised  by  means 
of  Fail-child's  pancreatic  extract,  or  Benger's  liquor 
pancreaticus. 

If  4  oz.  of  finely-minced  lean  meat  be  added  to 
half  a  pint  of  water,  and  then  gradually  brought  to 
a  boil,  then  half  a  pint  of  cold  water  be  added  so  as 
to  reduce  the  temperature  to  about  140°  F.,  and  then 
thirty  grains  of  Fairchild's  zymine  and  twenty  grains 
of  sodium  bicarbonate  be  added,  and  the  mixture 
kept  warm  for  about  three  hours,  the  meat  will  be 
peptonised. 

Peptonised  heef-tea  can  be  made  in  the  following 
manner : — Take  half  a  pound  of  finely-minced  lean 
beef,  add  to  it  a  pint  of  cold  water,  and  cook  over  a 
gentle  tire  till  it  boils.  Decant  the  beef-tea  into  a 
jar  or  bottle,  rub  the  meat  into  a  paste,  add  it  to  the 
beef-tea,  and  mix  in  another  pint  of  water  to  reduce 
the  temperature  to  about  140'  F.  Add  a  table- 
spoonful  of  liquor  pancreaticus,  or  sixty  grains  of 
Fairchild's  panci-eatic  extract,  and  twenty  grains  of 
sodium  bicarbonate.  Stand  in  a  warm  place  for 
three  hours,  shaking  occasionally;  then  boil  quickly 
for  two  or  three  minutes  and  strain. 

This  is  a  weak  beef-tea,  but  it  can  be  made  of  any 
strength  required. 

Following  this  method  various  foods  can  be  pre- 
digested  or  peptonised  according  to  the  wants  and 
tastes  of  the  invalids. 

Bauer  praises  very  highly  teube's  meat  solution, 
as  it  contains,  besides  peptones,  some  unaltered  albu- 
men. It  is  made  by  exposing  meat  and  dilute  hydro- 
chloric acid  to  a  high  temperature  in  air-tight  vessels. 

1,000  grammes  of  lean  meat  minced  fine  are 
placed  in  a  porcelain  vessel  with  1,000  centimetres 
of  water,   and  20  centimetres  of  pure  hydrochloric 


544  Food  in  Disease.  [Part  ii. 

acid.  This  is  placed  in  a  closed  Papin's  digester  and 
boiled  for  10  to  15  hours.  The  mass  is  then  taken 
out  and  rubbed  in  a  mortar  to  a  paste.  It  is  again 
boiled  in  the  closed  digester  for  another  16  to  20 
hours ;  after  this  it  is  neutralised  with  pure  sodium 
carbonate,  and  evapoiated  to  a  syrupy  consistence.* 

In  rectal  aliinciitatioii  the  unpleasant  flavour 
of  meat  peptones  is  no  bar  to  their  employment,  and 
they  have  been  found  very  useful  in  this  method  of 
artificial  feeding. 

But  it  is  necessary  to  inquire  here  to  what  extent 
the  nutrition  of  the  body  can  be  maintained  by  the 
administration  of  food  solely  in  the  form  of  rectal 
enemata  % 

It  has  been  ascertained  experimentally  that  soluble 
albumen,  such  as  is  contained  in  expressed  meat 
juice,  is  absorbed  in  the  rectum  to  nearly  the  same 
extent  as  complete  peptones ;  also  that  starch  is 
converted  into  sugar  and  absorbed  in  consideral)le 
quantity  \  egg  albumen,  when  mixed  with  a  small 
quantity  of  common  salt,  is  also  absorbed  ;  but  the 
mixture  is  too  irritating  to  be  suitable  for  enemata. 
Fat  in  emulsion  also  appears  to  be  absorbed  in  the 
rectum.  Solutions  of  peptones  appear  to  be  absorbed 
readily,  but  they  must  not  be  too  concentrated  or 
they  prove  irritating  to  the  mucous  membrane  of  the 
rectum,  and  they  are  then  not  retained.  Expressed 
meat  juice  and  peptones  seem,  then,  the  most  suitable 
foods  for  rectal  alimentation.  According  to  Bauer's 
observations,  under  no  circumstances  can  more  than 
a  fourth  part  of  the  amount  of  nourishment  necessary 
for  subsistence  be  absorbed  in  the  rectum  from 
nutrient  enemata,  as  its  capacity  is  limited,  and  the 
absorption  of  nutrient  inatters  therein  exceedingly 
slow. 

Leube  has  pointed  out  the  importance,  if  nutrient 

enemata  are  to  be  used  for  any  length  of  time,  of 

only  employing  substances  that  cannot  cause  the  leaat 

irritation  of  the   mucous  membrane  of  the  rectum, 

•  Bauer,  "Dietary  of  the  Sick,"  p.  88. 


Chap.  XII.]  Rectal  Alimentation.  545 

and  that  can  be  prepared  without  any  great  difficulty  ; 
and  he  has  suggested  enemata  of  meat  and  pancreas 
made  in  tlie  following  manner: — Mince  fine  150  to 
300  grammes  of  meat,  and  mix  with  50  to  100 
grammes  of  finely-chopped  pancreas,  free  from  fat. 
Beat  the  mixture  into  a  paste  with  a  pestle  or  spoon, 
adding  a  little  lukewarm  water  to  make  it  of  a 
suitable  consistence  for  injection  through  the  enema- 
tube.  Use  warm  ;  if  cold  it  may  excite  the  rectum 
and  cause  expulsion.  If  thought  desirable,  from  25 
to  50  grammes  of  fat  may  be  mixed  intimately  with 
the  mass  by  the  helj)  of  a  warmed  pestle.  A  syringe 
with  a  wide  nozzle  must  be  used.  '  Such  enemata 
cause  no  irritation  of  the  mucous  membrane  of  the 
rectum,  and  can  be  retained  from  12  to  3G  hours. 
Evidence  was  also  obtained  by  Leubo  that  a  con- 
siderable portion  of  the  albumen  and  fat  of  such 
enemata  was  absorbed.  Dujardin-Bcaumetz  particu- 
larly recommended  the  following  formula  : — To  a  cup 
of  milk  add  two  or  three  tablospoonfuls  of  lu^uid,  or 
two  or  three  teaspoonfuls  of  dry  peptone,  the  yolk 
of  an  Qa;n^^  five  drops  of  laudanum  and  seven  grains 
of  bicarbonate  of  soda  if  the  peptone  is  acid,  as  the 
contents  of  the  large  intestine  are  alkaline  or  neutral, 
and  never  acid. 

Owing  to  the  difficulty  of  keeping  pancreatic 
extracts  sweet.  Wood*  has  advised  the  preparation 
of  a  glycerine  extract  made  by  rubbing  down  bullock's 
pancreas  with  glycerine,  and  adding  some  of  this  to 
finely-divided  meat  for  each  injection  ;  l)ut  the  known 
aperient  action  of  glycerine  when  injected  into  the 
rectum  would  surely  lead  to  the  speedy  rejection  of 
such  enemata. 

Peptonised  milk  -  gruel  or  peptonised  beef  -  tea, 
mixed  with  some  soluble  carbohydrate,  such  as 
maltine,  or  a  mixture  of  one  of  the  malted  foods  and 
pe|)tonised  milk,  is  a  useful  preparation  for  rectal 
alimentation.  Small  quantities  of  wine  or  brandy  may 
be  added  lo  'iuch  enemala  when  stimulation  i.s  indicated. 
*  "Tlierupeutirs." 
J  J 


546  Foon  IN  Disease.  (Pan  11. 

It  is  advisably  tx)  wash  out  tlie  rectum  with  pure 
water  an  hour  before  admiuisteiing  a  nutrient  enema. 
Only  a  small  quantity  should  be  injected  at  a  time, 
from  1  oz.  to  3  oz.  ;  a  larger  quantity  is  liable  to  be 
rejected.  The  tube  should  be  well  oiled  to  avoid 
setting  up  soreness  or  irritation  at  the  anus,  and  it 
is  well  to  use  a  long  one  so  as  to  inject  the  fluid  as 
high  up  as  possible  in  order  that  it  may  come  in 
contact  with  a  more  extensive  absorbing  surface.  The 
enemata  must  not  be  given  too  frequently,  or  irritation 
of  the  rectum  and  intolerance  will  be  provoked — 
about  every  3  to  4  hours  according  to  circumstances. 
A  suitable  temperature  is  from  90  to  95°  F.  The 
addition  of  opium  to  the  injection  may  insure 
retention,  but  it  may  also  retard  absorption.  Re- 
tention is  favoured  by  placing  the  patient  on  the 
left  side  with  the  hips  well  raised. 

Peptonised  suppositories  are  also  prepared  con- 
taining peptonised  concentrated  milk,  or  meat,  to- 
gether with  digested  oil.  These  are  said  to  have 
sustained  life  for  weeks  without  exciting  any  rectal 
irritation.  But  we  know  instances  in  which  the 
rectum  and  lower  i)art  of  the  colon  have  been  found, 
post-mortem,  full  of  such  suppositories  quite  undi- 
gested. 

We  have  seen  that  it  is  impossible  to  maintain 
life  for  any  length  of  time  simply  by  rectal  alimen- 
tation. If  we  have  to  trust  to  this  alone,  we  can 
only  avert  death  from  starvation  for  a  brief  time, 
probably  for  two  or  three  weeks.  Not  only  is  the 
amount  of  nutriment  that  can  be  absorbed  by  the 
rectum  insufficient  for  the  maintenance  of  life,  but 
diarrhoea  is  extremely  liable  to  set  in  after  a  time,  so 
that  the  rectal  injections  are  no  longer  retained. 

As  a  temporary  exjiedient  rectal  alimentation  is 
exceedingly  useful  in  all  those  cases  in  which  there 
exists  a  mechanical  impediment  to  the  reception  of 
food  in  the  natural  way  ;  if  this  is  not  permanent  it 
may  afford  time  for  its  removal,  but  if  it  is  perma- 
nent it  can  only  prolong  life  for  a  few  weeks. 


Chap. XII.)         Rectal  Ai.iAfENTAriON.  547 

Rectal  feeding  is  also  a  useful  rcrfource  in  certain 
states  of  the  digestive  organs  in  which  they  are  in- 
tolerant of  the  presence  of  food,  and  in  which  it  is 
desirable  they  should  for  a  time  be  kept  at  rest,  or 
when  they  cannot,  from  feebleness  of  function,  digest 
sufficient  food ;  in  cases  of  obstinate  vomiting,  of 
gastric  ulcer,  of  acute  gastritis,  of  diphtheritic 
paralysis,  of  spasmodic  or  other  stricture  of  the 
cesophagus,  as  well  as  in  the  exhaustion  of  fevers, 
in  delirium,  and  in  other  conditions  which  it  is  not 
neces.sary  here  to  enumerate. 

Attempts  have  been  made  to  administer  food  by 
subcutaneous  injection  of  oils,  milk,  eggs,  and  other 
substances,  but  not  with  any  markedly  good  results ; 
indeed,  the  very  small  amount  of  nourishment  which 
could  under  any  circumstances  be  thus  administered 
renders  the  attempt  of  little  practical  utility. 


J  1-5 


APPENDIX   1. 


HOSPITAL    DIETARIES. 

No  precise  scientific  data  arc  available  for  estimating  the 
quantity  of  food  appi'opriate  and  sufficient  for  the  vavious 
classes  of  invalids  ;  and  when  it  is  considered  how  diflerent  are 
the  conditions,  as  affecting  the  nutritive  needs  and  digestive 
capacities  presented  by  different  individuals  suffering  not  only 
from  different  but  even  from  the  same  maladies,  it  would  seem 
aliuost  impossible  that  such  precise  and  accurate  data  should 
ever  be  obtainable.  Under  these  circumstances  our  only 
reliable  guide  is  that  furnished  by  the  prolonged  and  observant 
experience  of  those  who  have  had  the  direction  and  care  of 
institutions  adapted  for  the  reception  of  the  sick.  It  will, 
therefore,  be  of  some  practical  value  to  collect  together  and 
compare  a  cerUiin  number  of  these  dietaries  which  the  ex- 
perience of  such  institutions  has  shown  to  be  suitable  and 
sufficient. 

In  most  of  these  dietaries  wide  scope  is  usually  given  for 
the  introduction  of  "  extras,"  which  is  an  acknowledgment  of 
the  necessity  for  permitting  great  latitude  in  estimating  the 
quantity  of  food  requisite  for  individual  cases. 

In  the  estimate  made  by  Bauer,  from  the  fcibles  accessible 
to  him,  of  the  relative  quantities  of  albumen,  fat,  and  carbo- 
hydrates (in  grammes)  conkiined  in  the  dietaries  of  some  of 
the  i)rincipal  English  hospitiils,  the  variation*;,  especially  in  the 
quantity  of  fats,  appear  to  be  considerable. 

It  is  probable,  however,  that  these  calculations  were  made 
from  tables  that,  in  some  instances,  arc  no  longer  in  use. 


AJbuuicn. 

Fat. 

Cnrlx)- 
hydrates. 

ToUl. 

Middlesex  Hospital 

85 

23 

297 

410 

St.  Bariholomcw's  Ho^jiital   . 

83 

60 

291 

424 

(.'oiisiiiniition                 „ 

83 

32 

254 

369 

St.  George's                    „ 

100 

05 

308 

473 

Westminster                  ,, 

125 

43 

388 

55(5 

German                           ,, 

1)7 

G8 

309 

474 

Miirgate  Soa  Balliing  Intirmary 

123 

55 

438 

(316 

In  those  Hospitals  in  which  the  diets  are  classified 
mainly  into  "Full,"  "Middle,"  and  "  Milk  "  diets,  it  may  be 
instructive  to  compare  tliese  together.  Meat  is  "  cooked  "  in 
all  cases,  unless  the  contrary  is  slated. 


550 


Appendix  I. 
Full  Diets. 


Gux/s. 

King's  College. 

London. 

Bread,  14  oz. 

Bread,  12  oz. 

Bread,  12  oz. 

Butter,  1  02. 

Meat,  6  oz. 

Meat,  6  oz.  ;   fiinales, 

Meat,  6  oz. 

Potatoes,  \  lb. 

4  oz. 

\it«,.  ^  Mutton     broth, 
'"^J^-  J   pudding,  1  lb. 

PoUtoes,  \  lb. 
Gruel,  1  pint 

Potatoes,  i  lb. 

Porter,  inale.s,    1  pint; 

Porter,  males,  1  pint ; 

Porter,  1  pint ;  or  milk, 

females,  \  pint. 

females,  \  pint. 

1  pint 

(Or     milk,    instead    of 

Milk,  \  pint. 

porter. ) 

Tea  and  sugar. 

Bartholomew's. 

St.  Thomas's. 

University  College. 

Bread,  14  oz. 

Bread,  12  oz. 

Bread,  12  oz. 

Butter,  1  oz. 

Butter,  i  oz. 

Meat,  6  oz. 

Meat,  8  oz. 

Meat,  4  oz. 

Potatoes,  \  lb. 

Potatoes,     \    lb.    (or 

Potatoes,  \  lb. 

fresh  vegetables). 

Broth,  or  pea  soup, 
1  pint  (on  alternate 
days). 

Rice     pudding,     made 

Beer,     men,    2    pints ; 

Porter,  if  ordered. 

with  milk,  4  oz. 

women,  1  pint 

Milk,  1  pint 

Beer,  1  pint,  when  or- 

Tea, 2  pints. 

Tea,     IJ    pint;    with 

dered. 

milk  and  sugar. 

Milk,  1  pint 

Great 

Edinburgh 
Infirmary. 

Westminster. 

Northern, 

Women's. 

Bread,  14  oz. 

Bread,  12  oz. 

Bread,   14  oz.,  or 

Bread,  10  oz. 

Butter,  }  oz. 

Butter,  \  oz. 

Potatoes,  2  lb., 

Butter,  }  oz. 

Meat,  5  oz. 

Meat,  males,  6  oz.  ; 

in  place  of  11  oz.jMcat,  5  oz. 

PoUtoes,  i  lb. 

females.  4  oz. 

of  bread. 

Potatoes,  i  lb 

Milk  gruel,  1  pint 

Potatoes,  8  oz. 

Meat,  6  oz. 

(Other   veget\bles 

Broth,  2  iiints. 

Broth : 

on  3  days.) 

Milk,  \  pint 

Milk,  i  pint. 

Meat,  2  oz. 

Becf-t«a,  1  i)int. 

Tea,  i  oz. 

Tea   or    coffee,  \\ 

Barley,  1  oz. 

(Obtained  fioni 

Sugar,  1  oz. 

pint 

Vegets.,  i  oz. 

1     lb.     rujup 

Poriidge  : 

steak.) 

(Oatmeal,        4J 

Milk,  1  pint 

oz.),  li  pint 

Buttennllk,    20 

Milk  (new),    10 

oz. 

It  is  certainly  somewhat  remarkable  to  find  such  wide 
variations  as  are  apparent  in  the  above  tables  of  "  Full  Diets '' 
in  some  of  our  principal  hospitals,  especially  as  those  are  the 
diets  usually  allotted  to  convalescents  or  to  surgical  cases,  and 
they  are  diets  with  which  it  is  not  usual  to  order  "  extras." 

The  quantity  of  cooked  meat   varies    from   4   oz.   at    St. 


Hospital  Dietaries. 


551 


Thomas's  to  8  oz.  at  St.  Bartholomew's  !  In  four  no  butter  is 
provided,  and  in  the  other  the  quantity  allowed  varies  from 
^  oz.  to  1  oz.  In  such  essential  articles  of  diet  as  these  more 
uniformity  might  surely  be  expected. 


Middle 

Diets. 

Guy's. 

King's 
College. 

London. 

Bartholomew's. 

Bread,  12  oz. 

Bread,  12  oz. 

Bread,  12  oz. 

Bread,  12  oz. 

Butter,  1  oz. 

Butter,  }  oz.      • 

Meat,  4  oz. 

Meat,  men,  4  oz. ; 
women,  3  oz. 

Meat,  4  oz. 

Meat,  4  oz. 

Potatoes,  \  lb. 

Potatoes,  i  ll». 

Potatoes,  i  lb. 

Potatoes,  \  lb. 

OnuUernaleilityx: 

Mutton     broth. 

Gruel,  1  i.lr.t. 

' 

1      pint,      or 

milky        rice 

pucUIinfT,  i  lb. 

Porter,  J  pint ;  or 

Porter,  J  pint. 

Porter,  4  pint ;  or 

Beer,  1  pint. 

milk. 

Milk,  i  pint. 

milk,  \  pint. 

Tea  and  sugar. 

Tea,  2  pints. 

Universily 
College. 


Bread,  12  oz. 


Westminster. 


Bread,  10  oz. 
Butter,  I  oz. 
Meat,  3  oz. 


Great 
Northern. 


Meat,    4   oz. ;    c 

fish,  8  02. 
Potatoes,  \  lb. 
Soup    (with    b.T 

ley),  IJ  oz.  ;  oijTen,  i  oz. 

beef-tea,  1  pint  ;iSugar,  1  oz, 

or  rice  pudding, 

with  milk. 
Milk,  1  i>int. 
Bt'i  r  (if  ordered), 

?  I'int. 


Potatoes,  \  lb. 
Milk  gi-uel,  1  pint. 


Milk,  i  pint. 


Bread,  12  oz. 
Butter,  \  oz. 
Meat,  4  oz. 

Potatoes,  8  oz. 
Broth,  1  j  pint. 


Milk,  J  pint. 
Tea  or   coffee,  IJ 
pint. 


St,  Thomas's. 


Bread,  12  oz. 
Butter,  }  oz. 
Meat,  men,  4  oz. ; 

women,  3  oz. 
Potatoes,  i  lb.  01 

fresh  vegetables. 
Rice      or     bread 

padding,  8  oz. 


Milk  Diets. 


Bartholomew's. 


Bread,  12  oz. 

Butter,  I  oz. 

Milk,  li  pint ;  or  milk 

.    with  arrowroot,  rice, 

or  sago,  1  pint. 
Tea,  2  pints. 
Gruel. 


King's  College. 


Bread ,  8  o& 

Milk,  I  pint. 
Ri'je-milk,   i   pint ;  or 

rice,   or  bread    ))ud- 

diiig,  i  lb. 


St.  Thomas's. 


Bread,  12  oz. 

Butter,  J  i^i. 

Milk,  Ij  pint. 

Rice,  or  biead  pudding, 

ilb. 
Tea,  l\  pi'it,  with  milk 

and  su^ar. 


552 


Appendix  J. 
Milk  Diets  {concinucd). 


University. 


Bread,  12  oz. 

51  ilk,  2  pints. 
I>  •cf-tea,  1  pint. 
AiiowiQot,  2j 

°^-  Ko  jelly. 


Sugar,  1  oz 


t — 

.1 


Mailc  ill- 


Great  Northern. 


Bread,  12  oz. 

Milk,  3  I'ints. 

Uice  imdding,  \  lb.,  if 

ordered. 
Barley  water,  ad  lib. 


Guy's, 


Bread,  12  oz. 

Butter,  1  oz. 

Milk,  2  pints ;  or  milk, 
1  pint,  witli  rice,  sago, 
or  arrowroot. 

Bccf-tea,  \  pint,  if  or- 
dered. 

Gruel  and  bailey  water, 
ad  lib. 


Glasgotv  Infirmary. 

Women's. 

Bread,  8  oz. 
Milk,  3  pints. 
Uice,  2i  oz. 

Bread,  ad  lib. 
Butter,  3  oz. 
Milk,  2  pints. 
Beef-tea,  1  pint. 
Light  pudding,  \  i>int. 

In  these  diets  wo  may  also  notice  consideraWo  discrepancies 
as  to  quantity.  The  bread  varies  fioin  8  to  12  oz. ;  tlio  total 
amount  of  milk  from  \\  iniii  to  'i  pints.  Two  allow  a  large 
quantity  of  tea,  six  allow  no  tea.  Four  allow  butter,  and  four 
allow  no  butter. 


Some  other  hospitals  classify  their  diets  difftrently  ;  we 
will  compare  the  so-called  "  Ordinary  Diets "  of  these 
Institutions :  — 


St.  Mary^s. 


Bread,  12  OZ. 
B'ltter,  1  02. 
Meat,  4  OZ. 

Potatoes,  )j  lb. ;  or  other 

vegetable.s. 
Milk,  \  pint. 
Milk  or  beef-tea,  1  pint. 

Tea,  cofl'ee,  or  cocoa,  2 
pint.8,  with  sugar. 


St.  George's. 


Bread,  12  oz. 
Butler,  1  oz. 
Meat,  3  oz. 

Piitiitoes,  \  lb. 

Milk,  \  pint. 
Port^jr,  \  \n\it. 
Gruel,  1  pint. 
Tea,  2  oz.  weekly. 
Sugar,  J  lb.  weekly. 


Middlesex. 


Bread,  10  oz. 

Meat     (uncooked,     and 

with  bone),  6  oz. 
Potatoes,  I  lb. 

Milk,  J  pint. 

Beef-tea,  strong,  J  pint. 


Hospital  Dietaries. 


553 


Brompton. 


Bread,  13  oz. 

Butter,  1  oz. 

Meat,  4  oz. 

Egg,  or  bacon 

Potiitiies,  5i  oz. ;  and  othei-  vege 

lables. 
Milk,  K'"t''>  "r  soup,  \  jjint. 
I'mkiiuj;,  S  oz. 
Te!i,  coH'ee,  or  cocoa,  1  pint. 
Treacle. 


Jioyal  Chest. 


Bread,  12  oz. 

Meat,  4  to  6  oz. 

I'otatoes,  \  lb. 

Milk,  «  pint. 
Milk  or  cocoa,  j  pint 
Light  pudding  (wilii  milk  and  eggs), 
U  oz. 


It  is  cei-taiuly  regrcttuble  that  more  uniformity  in  the 
estimation  of  the  quantities  of  food  necessary  for  invalids  is  not 
observable  in  these  tables. 

Jn  some  hospitals  the  diets  are  not  specially  named,  but 
simply  numbered ;  as  in  the  following  : — 

Charing  Cross  Hospital. 

No.  1  Diet. — Milk,  4  pints ;  beef-tea,  I  pint. 

,,  2  „  — Bread,  9  oz.  ;  butler,  1  oz.  ;  broth  or  beef-tea, 
1  pint ;  milk,  2  jjints ;  milk  pudding. 

,j  3  ,,  — Bread,  12  oz.  ;  butter,  1  oz. ;  meat,  4  oz. ;  pota- 
toes, 4  lb.;  milk,  1  pint;  milk  pudding. 

„  4  „  — Bread,  12  oz. ;  butter,  1  oz. ;  meat,  6  oz. ;  pota- 
toes, ^  lb. ;  mUk,  1  pint ;  milk  pudding. 

Royal  Free  Hospital. 

No.  1  Diet.— Bread,  8  oz. ;  beef-tea,  |  pint ;  gruel,   1  pint ; 

cofiee,  5  pint;  milk,  ^  pint. 
„     2     „     — Bread,   12   oz. ;   soup,    1   pint  (with  boiled   riec, 

3  oz.) ;    gruel,   1  pint ;   coffee,  Is  pint ;  milk, 

i  pint. 
„     3     ,,     — Bread,   12  oz.  ;  meat  Uncooked),  8  oz.  (males) ; 

6  oz.  (females) ;  potatoes,  ^  lb. ;  gruel,  i  pint ; 

coffee,  Ih  pint ;  milk,  \  pint. 

The  following  hospitals  provide  a  "  Fish  "  diet :  — 

Middlesex.— ^r&xA,  10  oz.  ;  milk,  1  pint;  fish,  8  oz.  (whiting, 
cod,  plaice,  or  brill) ;  potatoes,  \  lb. 

St.  Gcojv/t'*-.  — Brtad,  12  oz. ;  butter,  1  oz. ;  milk,  J  pint; 
gruel,  1  pint;  fisli,  plain  boiled,  4  oz.  (whiting,  plaice, 
flounders,  or  haddock). 

7FoJ«c«'«.— Bread,  10  oz. ;  butter,  £  oz. ;  milk,  1.^  pint;  beef- 
tea,  1  pint ;  fish,  6  oz. ;  potatoes,  \  lb. 

London  i^tter.— Bread,  10  oz  ;  fish  (sole,  haddock,  cod,  or  brill, 
uncooked),  8  oz.  ;  potatoes,  8  oz. ;  cocoa,  I  oz. ;  sugar, 
•J  oz. ;  milk,  J  pint. 


554  Appendix  I. 

We  give  as  examples  the  full  diet  tables  of  the  following 
three  hospitals : — 

London  Hospital. 

Admission  Diet. — (For  all  patients  on  admission,  unless  other- 
wise ordered.)  Bread,  12  oz.  ;  milk,  2  pints;  beef-tea,  1 
pint. 

For  Children. — Bread,  8  oz. ;  millv,  1  pint ;  beef-tea,  |  pint. 

lull  Diet. — Bread,  12  oz. ;  potatoes,  8  oz. ;  meat,  6  oz. ;  porter 
or  milk,  1  jiint. 

Middle  Diet. — Bread,  12  oz. ;  potatoes,  8  oz. ;  meat,  4  oz. ; 
porter  or  milk,  ^  pint. 

Ili-er  Diet. —  Jlilk,  2  pints;  beef-tea,  1  pint. 

Children'' s  Diet. — Bread,  8  oz.  ;  potatoes,  6  oz.  :  meat,  2  oz. ; 
milk,  1  pint. 

Hydrocarbon  Diet. —  Bread,  12  oz. ;  fat  bacon,  4  oz.  ;  milk,  I 
pint ;  pudding  (arrowroot,  i  oz. ;  yolks  of  2  eggs ;  milk, 
I  pint). 

Diabetic  Diet. — Gluten  bread,  6  oz. ;  meat,  6  oz. ;  watercress ; 
gluten  bread  pudding  (soak  1  oz.  gluten  bread  in  \  pint 
milk  for  an  hour,  beat  up  with  an  egg,  and  1  oz.  gluten 
flour,  then  put  mixture  into  a  mould,  and  bake). 

Special  Diet. — Mutton  chop,  or  beef  steak  (8  oz.  uncooked) ;  or 
fish  (10  oz.  uncooked),  with,  in  each  case,  bread,  12  oz. ; 
potatoes,  8  oz. ;  and  milk  or  porter,  1  pint,  as  ordered. 

Ordinary  beef-tea  is  made  with  8  oz.  meat  to  the  pint. 
Children''s  Hospital. 

Milk  Diet. — Bread,  6  oz.  (with  butter)  ;  milk,  2  pints ;  rice,  or 

other  milk  pudding. 
3roth  Diet. — Bread,  't\  oz.  (with  butter  or  dripping) ;  milk,  1 J 

pint ;  mutton  broth,  made  with  vegetables,  \  pint. 
3eef-tea  Diet. — Bread,   5  oz,    (with  butter);    milk,    l\  pint; 

beef -tea,  13  oz. 
Fish  Diet. — Bread,  8  oz.  (with  butter,  dripping,  or  treacle)  ; 

milk,    1  pint  (or  milk,  \  pint,  and  cocoa,  ^  pint) ;  sole, 

boiled,  2^  oz. ;  potatoes,  mashed.  3  oz. 
Meat  Diet. — Bread,  6J  oz.  (with  butter,  dripping,  or  treacle) ; 

milk,  1  pint  (or  milk,  \  pint,  and  cocoa,  ^  pint)  ;  meat, 

2^  oz. ;  potatoes,  mashed,  4  oz. 

London  Fever  Hospital. 

Low  Diet. — Bread,  6  oz. ;  milk,  ^  pint ;  gruel,  1  pint ;  sugar,  \  oz. 
Beef-tea  Diet. — Bread,  4  oz. ;  milk,  1  pint ;  beef-tea,  1  pint. 
Middle  Diet. — Males:   bread,   10  oz.  ;    milk,   1   pint;   broth,   1 

pint ;  rice,  or  bread  (for  pudding),  2  oz. ;  egg  (for  pudding), 

I  ;  sugar  (for  pudding),  ^  oz.     Females  :  2  oz.  less  bread. 
Fish  Diet. — Males:  bread,  12  oz.;  fish  (sole,  haddock,  cod,  or 

brill,    uncooked),   8  oz. ;    potatoes,    8  oz. ;    cocoa,   1   oz. ; 

sugar,  ^  oz. ;  milk,  J  pint.     Females,  2  oz.  less  bread. 


Hospital  Dietaries.  555 

Ftill  Diet. — Males,  bread,  16  oz.  ;  meat,  12  oz.  {uncooked,  and 
without  bone) ;  potatoes,  12  oz. ;  cocoa,  1  oz. ;  sugar, 
§  oz.  ;  milk,  ^  pint ;  beer,  1  pint.  Females :  4  oz.  less 
bread,  2  oz.  less  meat ;  beer,  ^  pint. 

The  following  extras  may  be  prescribed  : — 

Beef-tea,  strong  beef-tea,  and  eggs,  as  ordered. 

Arrowroot,  J  oz. ;  custard  pudding — 1  egg,  |  pint  milk ;  5  oz. 

sugar ;  tea,  ^  oz.  per  day ;  sugar,  1  oz.  per  day ;  butter, 

1  oz.  per  day. 

Extras  which  are  largely  ordered  by  the  physicians  and 
surgeons  in  London  hospitals  are  thus  very  fully  enumerated 
in  the  diet  tables  of  the  Middlesex  Hospital : — 

Chops  (mutton  or  pork),  J  lb.  when  trimmed ;  steak,  rump, 
^  lb.  ;  chicken,  a  quarter ;  sausages,  ^  lb.  ;  rabbit,  a 
quarter;  tripe,  ^  lb. ;  bacon,  3  oz. ;  strong  beef-tea  (12  oz. 
beef  to  pint)  ;  jellg  beef-tea  (24  oz.  to  pint)  ;  broth  (neck  of 
mutton,  with  bone,  ^  lb.  to  pint),  without  meat;  chicken 
broth  (5  chicken  to  pint) ;  oysters,  greens,  suet  pudding 
(beef  suet,  1  oz. ;  flour,  2  oz.) ;  custard  pudding,  arrowroot, 
sago,  oatmeal  gruel  (3  oz.  to  pint)  ;  eggs.  Jellies,  porter,  ale, 
stout,  wine,  spirits,  oranges,  lemons,  meat  essences. 

The  hours  and  apportionment  of  food  are  exemplified  in  the 
following  extract  from  the  diet  tables  of  St.  Mary's  Hospital: — 

Ordinary  Diet. 

Breakfast,  6  a.m. — Tea,  coffee,  or  cocoa,  with  sugar,  1  pint ; 

milk,  J  pint ;  bread  and  butter. 
Dinner,   12  noon. — Meat,  4  oz. ;  potatoes,  or  other  vegetables, 

^  lb. ;  bread. 
Tea,  4  p.m. — Tea,  coffee,  or  cocoa,  with  BU3ar,  1  pint ;  milk, 

^  pint ;  bread  and  butter. 
Supper,  7  p.m. — Beof-tea,  milk,  oi   cocoa,  1  pint;  bread  and 

butter. 

New  York  Hospital. 

Daily  House  Diet  (furnished  to  all  patients  unless  otherwise 
specially  directed  by  the  attending  physician  or  Lui-geon  only). 

Bnahfast. — Oatmeal  or  hominy ;  tea  or  coffee,  with  milk  and 

sugar ;  bread  and  butter. 
Dinner. — Potatoes;    bread  and   butter;    one   or    more  of   the 

following    vegetables  :     turnips,    sweet    potatoes,    beets, 

spinach,  squash. 
Supper.  — Ti:f^,  with  milk  and  sugar  ;  bread  and  butter  ;  stewed 

or  fresh  fruit. 


556  Appendix  1. 

Tn  addition,  on  Sunday,  at  breakfast,  eggs  ;  at  dinner,  roast 
beef,  and  com-stair.'n  pudding.  Monday :  Brcakfasf,  bailed 
potatoes;  dinner,  Btotk  sonp,  stewed  beef  or  mutton,  rice 
piidding.  Tuesday :  Breakfast,  mutton  chop ;  dinner,  pea- 
soup,  roast  mutton,  bread  pudding.  JFednesday  :  Breakfust, 
fried  or  stewed  pettitoes ;  dinner,  roast  beef,  coru-starch 
pudding.  Thursday :  Breakfast,  eggs ;  dinner,  stock  soup, 
stewed  beef  or  mutton,  tapioca  pudding.  Friday :  Breakfast, 
salt  mackerel  or  cod-lisli ;  dinner,  bean  soup,  baked  fish,  rice 
pudding.  Saturday:  Breakfast,  beef -steak;  dinner,  corned 
beef,  cabbage,  bread  pudding. 

Restricted  Diet. 

Breakfast.  — Tea  or  coffee,  with  milk  acd  sugar ;  farinaceous 

food,  -with  milk  ;  eggs. 
Dinner.  —Soup ;    either  of  the  following  :    raw  oysters,  roast 

beef,  steak,  chicken  with  vegetables;  pudding  (broad,  rice, 

tapioca,  or  corn-starch). 
Supper. — Tea,  with  milk  and  sugar ;  bread,  with  butter ;  fruit, 

fi"esh  or  dried. 

Milk  Diet. 
Six  pints  of  milk  daily. 

The  above  two  diets  may  not  be  ordered  in  addition  to  the 
regular  house  diet,  but  only  as  a  substitute  for  it ;  but  the 
attending  physicians  and  surgeons  may  order  items  of  special 
diet  in  particular  cases. 

Articles  of  Special  Diet. 

Milk,  eggs,  beef-tea,  oysters,  corn-starch,  chops,  steak, 
chicken,  chicken  soup,  rice,  broth,  farina,  ice-cream,  salt  fish, 
jellies,  custards,  gruels. 


APPENDIX    n. 


THE   STERILISATION   AND   PASTEURISATION  OF 
MILK. 

It  is  well  known  that  milk  is  a  fluid  which  changes  rapidly  on 
exposure  to  the  air.  Germs  enter  it  from  the  atmosphere,  and 
warmtli  favours  their  development.  Milk  may  also  hecome 
contaminated  by  dilution  with  impure  water,  or  by  its  recep- 
tion into  vessels  that  are  not  perfectlj'  clean.  The  object  of 
sterilisation  and  pasteurisation  is  to  destroy  any  morbific  germs 
that  may  have  gained  access  to  this  fluid. 

Besides  the  lactic  acid  ferment,  the  following  pathogenic 
microbes  may  get  into  milk :  the  bacillus  of  the  green  diarrhoea 
of  infants ;  the  bacterium  coll  commune  (this,  if  abundant  and 
especially  virulent,  sets  up  infectious  diarrh(Ba) ;  the  filamentous 
genns  of  infantile  cholera  ;  the  bacillus  of  tubercle  (for  this  to 
happen  the  bovine  disease  must  be  greatly  advanced,  and  the 
udder  itself  the  seat  of  tubercle) ;  the  bacillus  of  typhoid  fever, 
from  dilution  with  impure  water,  and  others. 

The  complete  sterilisation  of  milk  is  by  no  means  an  easy 
matter.  It  is  true  that  the  typhoid  bacillus,  the  bacillus  of 
preen  diarrhoea  in  infants,  and  the  bacillus  of  tubercle,  are  all 
killed  at  a  temperature  of  70°  C,  and  the  raising  of  milk  to 
this  temperature  far  a  time  is  capable,  therefore,  of  destroying 
them  ;  but  a  few  living  spores  remain  which  require  a  heat  of 
107°  to  108°  C.  to  destroy;  but  these  develop  slowly,  and  for 
most  practical  purposes  a  heat  of  80°  C.  applied  to  the  24  or  48 
hours'  supply  ought  to  annihilate  the  injurious  microbes. 
Perfect  sterilisation  can  only  be  effected  by  submitting  the 
milk  to  the  action  of  continuous  steaming  for  two  hours  at  a 
temperature  of  248°  F. ,  or  for  30  minutes  at  a  temperature  of 
266°  F.,  but  this  produces  changes  in  the  milk  which  are  not 
desirable. 

There  is,  however,  a  method  of  intermittent  ateriliaation 
which,  on  theoretical  grounds,  should  be  preferable  to  all 
others,  but  it  is  so  inconvenient  in  pmetice,  and  requires  so 
much  time,  that  it  is  little  suited  for  extended  application,  and 
cannot  bo  carried  out  on  a  large  scale.  For  intermittent 
sterilisation  the  milk  should  be  heated  for  2  hours  to  lo8°- 
167°  F.,  then  kept  at  a  tem])errtturo  favourable  for  germ 
development— i.e.  about  101°  F. — in  order  to  permit  of  the 
undestroyed  spores  developing  into  ndult  bacteria.  It  should 
then  again  be  submitted  fur  2  hours  to  a  similar  temperature, 


558  Appendix  U. 

and  then  again  allowed  to  stand  for  several  days  at  1 04'  Y. 
These  consecutive  changes  of  toinporature  are  repeated  four  or 
five  times,  and  at  last  the  miliv  is  brought  to  a  temperature  of 
212°  F.  It  will  he  seen  that  this  is  far  too  troublesome  a 
process  to  be  of  praetical  value. 

We  must,  therefore,  he  content  with  partial  sterilisation, 
which  is  easily  carried  out.  The  most  dangerous  pathogenic 
germs  can  be  certainly  destroyed  by  heating  for  an  hour  at 
164°  to  167°  F.,  or  heating  for  three-quarters  of  an  hour  by 
steam  at  212°  F. 

"What  is  termed  pasteurisation  is  the  exposure  of  milk  to 
heat  at  comparatively  low  temperatures— 140°  to  147°  F. 
This  gives  the  milk  a  slight  flavour  of  having  been  cooked, 
■which  disappears  on  cooling;  but  if  heated  to  158°  F.,  it 
suffers  permanent  change  in  taste.  It  is,  therefore,  more 
agreeable  to  the  taste  than  sterilised  milk,  and  this  heat  is 
sufficient,  according  to  some  authorities,  to  destroj'  all  bacteria 
likely  to  be  present.  It  does  not,  however,  keep  so  well  as 
sterilised  milk.  It  must,  of  course,  be  understood  that  Pas- 
teurisation does  not  kill  all  the  bacterial  spores,  and  that  it 
only  temporarily  checks  fermentation,  that  it  does  not  destroy 
the  tubercle  bacillus,  and  it  is  better  to  boil  the  milk  when  the 
presence  of  this  microbe  is  suspected.  The  pasteurisation  of 
milk  hHS  been  found  to  do  much  to  reduce  the  spread  of  disease 
among  infants  whose  sole  food  is  milk.  The  introduction  of 
the  use  of  pasteurised  milk  amongst  the  poor  people  in  New 
York  has  greatly  reduced  the  infant  mortality  during  the  hot 
summer  months. 

With  regard  to  the  relative  digestibility  and  nutritious 
qualities  of  pasteurised  and  sterilised  milk,  there  has  been 
much  debate.  With  regard  to  pasteurisation,  it  is  probable 
that  this  does  not  impair  these  qualities  to  any  extent. 

In  this  connection  the  following  account  of  the  changes 
induced  in  milk  by  boiling,  by  J.  L.  Kerr,  of  Aberdeen,  is  very 
interesting : — 

"  Milk  consists  of  a  multitude  of  cells  suspended  in  serum. 
The  cells  are  fat  cells  which  form  the  cream ;  the  remaining 
cells  are  nucleated,  and  of  the  nature  of  white  blood  corpuscles. 
The  serum  consists  of  water,  in  which  are  dissolved  milk  sugar 
and  serum  albumin,  with  various  s.'ilts,  and,  chief  of  all,  casein. 
The  cells,  with  the  exception  of  the  fat  corpuscles,  are  all 
living  cells,  and  they  retain  their  vitality  for  a  considerable 
time  after  the  milk  is  dniwn  from  the  mammary  gland. 

♦'Milk  kept  a  few  days  may  be  perfectly  sweet— that  is, 
unsoured,  but  it  has  a  different  taste  and  appearance,  and 
shows  a  tendency  to  separate  into  serum  and  the  more  solid 
portions,  which  tend  to  sink  to  the  bottom  of  the  vessel.  This 
change  in  taste  and  emulsification  is  due  to  the  death  of  the 
white  blood  corpuscle-like  hodies  contained  in  the  milk. 

"  There  is  reason  for  supposing  that  when  fresh  milk  is 


Sterilisation  of  Milk.  559 

ingested  the  living  cells  are  at  once  absorbed  without  any 
process  of  digestion,  and  enter  the  blood  stream  and  are 
utilised  in  building  up  the  tissues.  The  casein  of  the  milk 
is  digested  in  the  usual  way  of  other  albuminoids  by  the 
gastric  juice,  and  absorbed  as  peptone.  Tbira  is  also  absorp- 
tion of  serum  albumin  by  osmosis. 

"  The  chemical  result  of  boiling  milk  is  to  kill  all  the  living 
cells  and  to  coagulate  all  the  albuminoid  constituetits.  Milk  after 
boiling  is  thicker  than  it  was  befoi-e. 

"  The  physiological  results  are  that  all  the  constituents  of 
the  milk  must  be  digested  before  it  can  be  absorbed  into  the 
system ;  therefore  there  is  a  distinct  loss  of  utility  in  the 
milk,  because  the  living  cells  of  fresh  milk  do  not  enter  into 
the  circulation  direct  as  living  protoplasm,  and  build  up  the 
tissues  direct,  as  they  would  do  in  fresh  unboiled  milk. 

"  In  practice  it  will  have  been  noticed  by  most  medical 
practitioners  that  there  is  a  very  distinctly  appreciable  lowered 
vitidity  in  infants  that  are  fed  on  boiled  milk.  The  process 
of  absoi-ption  is  more  delayed,  and  the  quantity  of  milk  re- 
quired is  distinctly  larger  for  the  same  amount  of  growth  and 
nourishment  of  the  child  than  is  the  case  when  fresh  milk  is 
used." 

For  nutiitive  value,  no  doubt,  as  Dr.  Thomson  of  New 
York  observes,  that  milk  is  the  best  which  is  "  drawn  by  clean 
hands  from  the  (healthy)  cow  into  bottles  that  have  been 
sterilised  by  boiling  water,"  for  this  is  "  gerni-fi>ee  and  need 
not  be  further  treated."  Milk  in  the  uncooked  condition  is  no 
doubt  more  speedily  digested  than  after  it  has  been  boiled. 

However,  in  Heubner's  polyclinic  in  Leipzig,  in  the  case  of 
sick  children  suffering  for  the  most  part  fiom  ga-itro-intfstinai 
disorders,  the  nutritive  value  of  sterilised  milk  was  practically 
tested,  and  the  result  was  altogether  satisfactory.  Tlie  milk 
was  sterilised  according  to  Soxhlet's  method,  and  30  grammes 
of  sugar  of  milk  were  added  to  each  litre,  so  as  to  make  it  more 
like  human  milk  in  composition. 

Several  methods  have  been  suggested  for  carrying  out  in 
practice  the  stcrilisfition  of  milk ;  one  of  the  simplest  and  least 
troublesome  seems  to  us  that  designed  by  Mr.  C.  W.  Cathcart, 
of  Edinburgh.  It  is  by  its  cheapness*  and  simplicity  particu- 
larly well  adapted  to  the  use  of  the  poorer  classes,  whoso 
infants  are  precisely  those  most  exposed  to  the  risks  of  a 
contaminated  milk  supply.  Mr.  Cathcart's  apparatus  fulfils 
the  following  conditions  :  1st,  it  has  a  capacity  of  50  to  60  oz., 
i.e.  enough  milk  for  the  24  hours'  feeding ;  2nd,  it  is  easily 
heated  in  a  pot  of  a  size  to  be  found  in  workmen's  houses ; 
3rd,  it  is  provided  with  a  means  of  stirring  the  mixture  so  as 
prevent  the  cream   from  accumulating  at  the  top ;    4th,   it 

*  The  apparatus  costs  5s.  M.,  and  is  supplied  by  Archibald 
Gilchrist,  22,  Nicolson  Street,  Edinburgh. 


560  Appendix  II. 

permits  the  quantity  required  for  each  feeding  to  he  withdrawn 
without  risk  of  contaminating  the  remainder;  5th,  every  part 
is  easily  accessible  for  cleaning. 

The  apparatus  (Fig.  1)  consists  of  a  tin  can  6  in.  deep,  6  in. 
broad  at  top,  5  in.  broad  at  bottom,  and  it  fits  easily  into  a 
pot  in  common  use  amongst  (ho  poorer  classes  in  Scotland. 
The  can  is  raised  on  three  low  studs  to  allow  water  to  pass 
below  it  when  it  stands  in  the  pot.  It  is  provided  with  a 
nickel-plated  tap,  soldered  in  just  above  the  bottom,  and  it  has 


Fig.  1. — catiicaut's  milk  stkuilisek. 

two  stout  tinned  wire  handles  at  the  top  for  lifting  it  out  of 
the  pot.  The  lid  fits  on  to  an  inner  rim  so  as  to  ensure  that 
the  outer  surfaces  of  the  lid  and  can  are  flush ;  over  this 
juncture  an  indiarubber  band,  R,  is  slipped  to  ensure  against 
entry  of  air.  In  the  centre  of  the  lid  is  a  funnel-shaped 
aperture  |  in.  in  diameter.  The  "stirrer"  is  a  rectangular 
piece  of  tin  bent  into  the  form  of  a  ship's  screw,  with  a  long 
tinned  wire  handle,  which  rests  below  in  a  depression  in  tht! 
bottom  of  the  can  and  projects  above  through  the  aperture. 
It  is  used  in  the  following  manner :  The  quantity  of  food 
required  for  24  hours  is  poured  into  it,  the  stiner  is  placed  in 
position  and  the  lid  pressed  on,  with  the  handle  of  the  stirrer 
projocting  thrciugh  the  aperture.     The  steriliser  is  then  put 


Sterilisation  of  Milk.  561 

into  the  pot,  which  has  previously  been  about  a  quarter  filled 
with  water  brought  to  the  boil.  It  is  kept  in  this  pot  of  boil- 
ing water  for  about  twenty  minutes,  and  the  mixture  agitated 
occasionally  by  rotating  the  stirrer.  The  can  is  then  taken 
out  of  the  pot,  the  broad  rubber  band  supplied  with  the 
apparatus  is  slipped  over  "the  junction  of  lid  and  can,  and  some 
clean  absorbent  cotton-wool  packed  round  the  projecting  end 
of  the  stiiTer  in  the  funnel-shaped  aperture  in  the  lid.  The 
steriliser  is  then  put  in  a  cool  place.  Before  each  feeding  the 
mi.xture  is  agitated  by  the  stirrer  and  the  quantity  required 
diawn  off  into  the  feeding-bottle,  in  which  it  is  warmed  by 
placing  it  in  hot  water.  The  air  which  replaces  the  milk 
withdrawn  through  the  tap  must  pass  through  the  cotton-wool 
in  the  aperture  in  the  lid  and  is  thus  deprived  of  germs.  Aa 
to  the  temperature  to  wliich  the  milk  is  raised  in  this  way, 
Mr.  Cathcart  states  that  he  found  that  if  40  oz.  of  Roche's 
cream  mixture  were  placed  in  the  can  at  66°  F.,  a  thermometer 
suspended  in  the  mixture  registered,  five  minutes  after  the  can 
had  been  placed  in  the  pot  of  boiling  water,  175°  F,  In  ten 
minutes  it  reached  203°  F.,  and  in  fifteen  minutes  206°  F., 
at  which  point  it  remained  stationary. 

Mr.  Cathcart  doubts  if  the  nutritive  qualities  and  the  digesti- 
bility of  the  milk  are  interfered  with  to  any  serious  degree  by 
this  mode  of  sterilisation.  He  states  he  has  used  this  milk  for 
delicate  infants  in  his  own  family,  and  has  known  of  its  use  in 
a  great  number  of  similar  cases  in  private  practice  and  with 
the  best  results.  It  has  never  failed  to  nourish,  but  existing 
diarrhoea  has  ceased  and  the  infants  have  put  on  flesh. 

Soxhlet's  method  for  sterilising  milk  sufliciently  for 
practical  purposes  is  thus  described  by  Budin*  : — In  a  wide- 
necked  bottle  of  special  shape  the  quantity  of  milk  necessary 
for  one  feeding  is  placed,  and  this  is  heated  in  a  water-bath  for 
from  30  to  4o  minutes  (Fig.  3).  To  prevent  germs  entering  the 
bottles  after  they  have  been  withdrawn  from  the  bath,  where 
they  have  been  kept  for  half  an  hour  in  boiling  water,  a  special 
arrangement  is  adopted  to  keep  the  bottles  constantly  air-tight. 
This  consists  in  a  disc  of  caoutchouc  of  suflBcient  thickness 
which  is  placed  over  the  mouth  of  the  bottle  and  kept  in  place 
by  a  metal  capsule.  This  caoutchouc  disc  allows  the  vapour 
of  water  to  raise  it  whilst  in  this  water  bath,  but  when  the 
bottle  cools  the  steam  inside  it  condenses  and  a  relative  vacuum 
is  thus  produced  ;  then  the  caoutchouc  disc  becomes  depressed 
into  the  neck  of  the  bottle  by  atmospheric  pressure  (Fig.  2).  So 
long  as  this  disc  is  seen  to  be  firmly  depressed  we  can  be 
assured  that  no  air  has  penetrated  into  the  bottle.  The  milk 
which  has  simply  been  heated  in  a  water-bath  and  not  boiled  in 
contact  with  the  air  has  not  a  cooked  taste  but  preserves  a 
pleasant  flavour.     When  the  infant  has  to  be  fed,  the  bottle  is 

•  Conference  sur  I'Hygienc  de  I'Enfance  :  Allaitment.  Paris,  1892. 
K  K 


562 


APlhNDlX  II. 


t'ig.  2.— To  the  left  is  tlie  upper  part  of  a  wide-monthed  bottle  on  which 
is  placed  a  caoutchouc  disc.  In  the  middle  is  the  metal  capsule  used 
to  l>eep  tlie  disc  iu  jilace.  To  the  right  is  shown  the  caoutchouc  disc 
depressed  iuto  the  neck  of  the  bottle  by  atmospheric  pressure. 


opened  and  emptied  into  a  feeding-bottle  which  has  been  just 
washed  out  with  boiling  water.  As  each  bottl-^  only  contains 
enough  for  one  feeding,  there  is  never  any  leit  behind  to 
become  contaniina  te J. 


Fig.  3. — Section  of  tlie  saucepan  for  heating  the  milk  in  boiling  water. 
It  contains  a  metallic  sujipdit  for  the  bottles,  which  arc  capsuled  in 
llie  manner  descrilwd  in  tlie  text  and  iliiislrated  in  Fig.  2. 


Sterilisation  of  Milk. 


563 


To  prevent  any  contamination  of  the  milk  after  sterilisa- 
tion is,  of  course,  most  important,  and  to  ensui'e  this  so  fsir  as 
possible,  M.  Budin  discards  all  long  tubes  and  uses  a  feeding- 
bottle  of  the  following  description.  To  an  ordinary  bottle 
is  fitted  a  special  stopper,  which  he  terms  a  "  galactophore  " 
(Fig.  4) .  This  consists  of  an  indiarubber  cork  through  which 
pass  two  tubes  side  by  side,  the  larger  one  to  allow  the  outflow 
of  milk,  the  smaller  ono  the  entrance  of  air.    An  indiarubber 


GALAOTOPHCRB, 


Ai  Two  tnbes  aide  by  side  for  the  purpose  of  allowing  milk  to  flow  out  and 
sir  to  pass  in.  B,  Small  indiHruhbcr  stopper  throuKU  wbich  the  instrument 
is  inssed.  C,  Bottle  tilled  with  milk  on  wliicb  the  galaclophore  has  been 
fitted,  furnished  with  a  nipple  and  a  flat  ring  of  bone. 


nipple  and  a  flat  ring  of  bone  complete  the  apparatus.  The 
bottle  is  filled  with  milk,  and  corked.  It  is  then  inverted  and 
the  nipple  placed  between  the  lips  of  the  infant.  As  soon  as 
it  makes  a  sucking  movement  the  milk  flows  into  the  mouth. 
The  tube  for  the  admission  of  air  must  be  veri/  small,  so  that 
the  milk  cannot  escape  by  it  and  the  air  does  not  enter  too 
rapidly. 


KK  2 


APPENDIX    III. 


INVALIDS'   DIETARY.- SELECT   RECIPES. 

1.  Almond  Cakes  for  Diabetics  (Seegen's),  page  383. 

2.  Almond    Biscuits   (for    Diabetics). — To   every  ounce   of 

almond  flour  add  two  whites  of  eggs,  and  a  little  salt  to 
taste.  Beat  the  whites  to  a  stiff  froth,  add  the  almond 
flour,  and  beat  well  together.  Put  in  buttered  patty -pans, 
and  bake  in  a  moderately  quick  oven  from  fifteen  to  twenty 
minutes.  The  whole  has  to  be  done  quickly,  and  baked 
directly  the  ingredients  are  mixed.     (Hart.) 

3.  Almond    Pudding   (for    Diabetics). — Take    two    eggs,   a 

quarter  of  a  pound  of  almond  flour,  a  quarter  of  a  pound 
of  butter,  and  three  tabloids  of  saccharin.  Dissolve  in 
a  tablespoonful  of  brandy.  Warm  the  butter,  beat  in  the 
almond  flour  and  the  yolks  of  the  eggs,  adding  the  dis- 
solved saccharin.  Whisk  the  whites  into  a  stiff  froth  ; 
beat  all  together.  Put  into  dariole  moulds  and  bake  in 
a  quick  oven,  and  servo  with  a  little  hot  sauce  made  with 
dry  sherry  and  saccharin.     (Hart.) 

4.  Alum  Whey  {an  astringent  drink). — To  a  pint  of  boiling 

milk  add  \  oz.  of  powdered  alum  previously  mixed  with 
three  or  four  tablespoonfuls  of  hot  water.     Strain. 

5.  Arrowroot. — Mix  two  teaspoonf  uls  of  arrowroot  with  three 

tablespoonfuls  of  cold  water ;  add  half  a  pint  of  boiling 
water,  constantly  stirring.  Milk  may  be  used  instead  of 
water.  Flavour  with  sugar,  nutmeg,  lemon-peel,  or  other 
spice.  Add  port  wine  or  brandy,  if  required.  (Some  advise 
boiling  for  three  minutes  in  an  enamelled  saucepan.) 

6.  Artificial  Human  Milk  (Frankland's),  pnge  255. 

7.  Barley  Jelly  (Eustace  Smith),  page  259. 

8.  Barley  Water.— On  a  tablespoonful  of  pearl  barley  (washed 

in  cold  water),  the  rind  6i  a  lemon  peeled  thin,  and  two  or 
three  lumps  of  sugar,  pour  a  quart  of  boiling  water.  Let 
it  stand  for  seven  or  eight  hours,  and  strain.  More  or  less 
of  the  juice  of  the  lemon  may  be  added,  according  to  taste. 

9.  Barley  Water  (Bartholow). — Wash  2  oz.  of  pearl  barley 

w^ith  cold  water.  Then  boil  it  for  five  minutes  in  some 
fresh  water,  and  thi-ow  both  waters  away.  Then  pour  on 
two  quarts  of  boiling  water,  and  boil  it  down  to  a  quart. 
Flavour  with  thinly-cut  lemon-rind,  and  sugar  to  the 
taste ;  but  do  not  strain  unless  at  the  patient's  request. 


Select  Recipes.  565 

10.  Beef  Essence,  page  331. 

11.  Another. — Chop  up  very  fine  a  pound  of  gravy-beef  free 

from  fat  and  skin ;  add  a  little  salt,  and  put  it  into  an 
earthen  jar  with  a  lid ;  fasten  up  the  edges  with  a  thick 
paste,  such  as  is  used  for  roasting  venison  in,  and  place 
the  jar  in  the  oven  for  three  or  four  hours.  Stram 
through  a  coai-se  sieve,  and  give  the  patient  .two  or  three 
tablespoonfuls  at  a  time. 

1?.  Beep  Juicb  (Bartholow).— Broil  quickly  some  pieces  of 
round  or  sirloin,  of  a  size  to  fit  in  the  cavity  of  a  lemon- 
squeezer.  Both  sides  of  the  beef  should  be  quickly 
scorched  to  prevent  the  escape  of  the  juices,  but  the 
interior  should  not  be  fully  cooked.  As  soon  as  ready, 
the  pieces  should  be  pressed  in  the  lemon-squeezer,  pre- 
viously heated  by  being  dipped  in  hot  water.  The  juice, 
as  it  flows  away,  should  be  received  into  a  hot  wine-glass, 
and  after  being  seasoned  to  the  taste  with  salt  and  a  little 
cayenne  pepper,  taken  while  hot. 

13.  Beef-Tea  (Bartholow). — Chop  fine  a  pound  of  lean  beef, 

free  from  fat,  tendons,  etc.,  and  digest  with  a  pint  of  cold 
water  for  two  hours.  Let  it  simmer  on  the  stove  for  three 
hours  at  a  temperature  never  over  160°  Fahr.  Make  up 
the  water  lost  by  evaporation  by  adding  cold  water,  so 
that  a  pint  of  beef- tea  shall  represent  a  pound  of  beef. 
Strain,  and  cai'efully  express  all  fluid  from  the  beef. 

14.  Beef-Tea  (Pavy). — Put  a  pound  of  finely-minced  beef  into 

a  suitable  vessel  with  a  pint  of  cold  water.  Let  it  stand 
for  an  hour,  stirring  occasionally.  Place  the  vessel  con- 
taining the  besf  into  a  saucepan  of  water,  place  it  over 
the  fire,  and  allow  the  water  to  boil  gently  for  an  hour 
(or  the  vessel  containing  the  beef-tea  may  be  put  into  an 
ordinary  oven  for  an  hour).  Pass  the  beef-tea  through 
a  strainer.  It  contains  a  quantity  of  fine  sediment,  which 
should  be  drank  with  the  liquid.  Flavour  with  salt.  In 
this  process  the  beef  extract  should  not  be  exposed  to  a 
temperature  of  more  than  170"  Fahr. 

15.  Beef-Tea  (Germain  See),  page  311. 

16.  Beef-Tea.  — Cut  up  a  pound  of  lean  beef  into  pieces  the 

size  of  dice ;  put  it  into  a  covered  jar  with  two  pints  of 
cold  water  and  a  pinch  or  two  of  salt.  Let  it  warm 
gradually  and  simmer  for  a  couple  of  hours,  care  being 
taken  that  it  does  not  reach  the  boiling  point. 

17.  Beef-Tea,    Flavoured. — Beef -tea    may    be    agreeably 

flavoured  by  boiling  in  it  a  pinch  of  mixed  herbs,  a  bay- 
leaf,  or  a  little  onion,  carrot,  turnip,  or  celery  and  a  few 
peppercorns.  The  roots  should  either  be  chopped  small 
or  be  scraped  to  pulp  before  being  put  into  the  broth. 


566  Appendix  III. 

18.  Beef-Tea  with    Oatmeal. — Mix   thoroughly  one  table- 

spoonful  of  giojits  with  two  of  cold  water,  add  to  this 
a  pint  of  boiling  beef-tea.  Boil  for  ten  minutes,  stirring 
all  the  time,  and  strain  through  a  coarse  sieve. 

19.  Biedeii's  Cream  Mixture,  page  262. 

20.  Bouillon,  American  (American  Broth). — Place  in  a  tin 

vessel  that  can  be  hermetically  closed,  alternate  layers  of 
finely-minced  meat  and  vegetables.  Seal  it  up  and  keep 
it  heated  in  a  water-bath  (ha\n-marie)  iax  six  or  seven 
hours,  and  then  press  out  the  broth. 

21.  Bouillon  (Broth)  as  used  in  the  hospitals  of  Paris. — 

Raw  ment,  without  bone  1  kilogramme  (about  2J  lb.) 

Fresh  vegetables    -         -     400  grammes  (about  1  lb.) 
Salt       -        -        -        -       10        „        (about  150  grs.) 
Should  be  boiled  very  slowly  over  a  very  gentle  fire. 

22.  Bran  Cakes  (Camplin's),  page  381. 

23.  Brandy  and  Egg  IMixture,  page  311. 

24.  Biiead-Jelly  {for  the  preparation  of  an  artificial  food  for 

infants). — Take  4  oz.  of  crumb  of  bread  two  or  three 
days  old,  soak  in  cold  water  for  six  or  eight  hours  ;  then 
squeeze  all  the  water  out  of  it  (lactic  acid  and  other 
peccant  matters  are  thus  removed).  Place  the  pulp  in 
fresh  water,  and  boil  gently  for  an  hour  and  a  half,  so  as 
to  break  up  the  granules  of  starch,  and  promote  its  con- 
version into  dextrin  and  glucose. 
V  Rub  this  semi-fluid  gruel  through  a  fine  hair-sieve; 
when  cold,  it  forms  a  smooth  jelly. 

It  will  not  keep  long,  and  must  be  prepared  twice  daily. 

I'or  children  who  can  digest  no  milk,  this  jelly  may 
be  simply  mixed  with  enough  warm  water  (one  table- 
spoonful  to  8  oz.  of  water)  so  as  to  have  the  consistence 
of  thin  cream,  and  a  little  refined  sugar  added- 

To  make  it,  however,  a  suitable  food  for  more  than 
mere  temporary  purposes,  it  would  need  the  addition  of 
some  albuminate  and  some  fat.  Its  percentage  com- 
position, mixed  in  the  proportions  stated,  is  proteids  0'74, 
fat  013,  carbohydrate  4-15. 

If  the  addition  of  milk  can  be  tolerated,  then  a  mixture 
of  3  oz.  of  bread-jelly  to  4  oz.  of  milk  (or  peptonised 
milk)  and  4  oz.  of  water  will  make  a  fairly  good  food ;  or 
the  necessary  amount  of  proteid  and  fat  may  be  obtained 
by  the  addition  of  raw-meat  juice  and  cream  (the  raw- 
meat  juice  being  prepared  by  expression  from  a  mixture 
of  four  parts  meat  and  one  part  water). 

Dr.  Chcadle  *  recommends  as  a  highly  nutritious  food 
for  children  a  mixture  of  four  parts  of  the  above  bread- 

•  "ArtiBctal  Feeding  of  Infants." 


Select  Recifes.  567 

jelly  mixture  (with  water  only),  three  pnrts  of  raw-meat 
juice,  half  a  pint  of  cream,  and  onc-fit'th  part  of  sugar. 
The  raw-meat  juice  must  be  quite  fresh,  and  miido  twice 
a  day. 

2.'>.   Broth,  Ck)ld  (Pailte's),  page  158. 

26.  Caudle. — Beat  up  an  egg  to  a  froth  ;  add  a  glass  of  sherry 

and  half  a  pint  of  gruel.  Flavour  with  lemon  peel,  nut- 
meg, and  sugar. 

27.  Celery  stewed,  for  Rheumatism,  page  87. 

28.  Cheese-Cakes  (for  Diahetics). — Tal<o  a  pint  of  milk,  half 

a  tablespoonful  of  rennet,  1  oz.  of  butter,  two  eggs,  one 
tablespoonful  of  brandy,  \  oz.  of  almonds  and  Sflcchaiin. 
Turn  the  milk  to  a  curd  ;  let  it  stand  in  a  warm  place  till 
thoroughly  set,  tie  a  piece  of  muslin  over  a  bowl,  break 
up  this  curd  and  pour  it  on  to  the  muslin  ;  leave  it  till 
all  the  whey  has  run  off.  Beat  the  curd  smooth  and  add 
the  butter  and  egg.",  well  beaten  with  the  brandy,  almonds, 
and  saccharin.  When  well  mixed  together,  pour  some 
of  the  mixture  into  e:ich  of  the  patty-pans,  and  bake  for 
about  fifteen  or  twenty  minutes.     (Hart.) 

29.  Chicken  Broth  (Bartholow).  —  Skin  and  chop  up  small  a 

small  chicken,  or  half  a  large  fowl,  and  boil  it,  bones  and 
all,  with  a  blade  of  mace,  a  sprig  of  parsley,  and  a  crust 
of  bread,  in  a  quart  of  water,  for  an  hour,  skimming  it 
from  time  to  time.     Strain  through  a  coarse  colander. 

30.  Chicken,   Veal,   or  ^Iutton  Broth  may  be  made  like 

beef-tea  (Xo.  11),  substituting  chicken,  veal,  or  mutton 
for  beef,  boiling  in  a  saucepan  for  two  hours,  and 
straining.  For  chicken  broth  the  bones  should  be  crushed 
and  added.  For  veal  broth  the  fleshy  pai-t  of  the  knuckle 
should  be  used.  Either  may  be  thickened  and  their 
nutritive  value  increased  by  'he  addition  of  pearl  barley, 
rice,  vermicelli,  or  semolina. 

31.  Chicken  Panaiu. — Take  tho  flesh  from  the  breast  of  a 

fresh-roasted  diii  ken ;  soak  the  crumb  of  a  French  roll 
or  a  few  ru.«ks  in  hot  milk,  and  put  this  in  a  clean  stew- 
pan,  with  the  meat  from  the  chicken  previously  reduced 
to  a  smooth  pulp  by  chopping  it  and  pounding  it  ia  a 
mortar;  add  a  little  chicken  bioth  or  plain  water,  and 
stir  the  panada  over  the  fire  for  ten  minutes. 

32.  Coffee  Jelly. — Soak  ^  oz.  of  gelatine  in  half  a  pint  of 

water  for  an  hour,  dissolve,  and  add  a  breakfastcupful  of 
strong,  clear  coffee.  Sweeten  to  tiiste,  mould,  add  a  little 
cognac  if  liked,  and  serve  when  firm.  Tea  jelly  may  be 
made  in  the  same  way. 


568  Appendix  III. 

33.  Egg  Cordial. — Beat  the  white  of  an  egg  to  a  froth,  add  a 

tablespoonful  of  cream  and  a  tablcspoonful  of  brandy. 

34.  Egg  Drink. — Mix  a  tablespoonful  of  the  best  arrowroot 

to  a  smooth  paste  with  cold  water.  Add  two  table- 
spoonfuls  of  white  sugar  and  the  whites  of  two  eggs 
which  have  been  whisked  with  a  little  water.  Add 
boiling  water  to  make  up  the  quantity  to  three  pints, 
boil  up  once  quickly,  and  stir  whilst  boiling. 

36.  Egg  Lemonade. — Shake  together  in  a  bottle  the  white  of 
an  Q%%,  a  tumblerful  of  cold  water,  the  juice  of  half  a 
small  lemon,  and  a  teaspoonful  of  white  sugar. 

36.  Egg-nog  (Bartholow)  [a  nuiritire  drink  in  acute  disease). — 

Scald  some  new  milk  by  putting  it,  contained  in  a  jug, 
into  a  saucepan  of  boiling  water,  but  it  must  not  be  allowed 
to  boil.  When  quite  cold,  beat  up  a  fresh  egg  with  a  fork 
in  a  tumbler  vdth  some  sugar ;  beat  quite  to  a  froth  ;  add 
a  dessertspoonful  of  brandy,  and  fill  up  the  tumbler  with 
scalded  milk. 

37.  Enema  of  Meat  and  Pancreas  (Leube's),  page  544. 

38.  Entire  Wheat-meal  Cakes  (Sir  Henry  Thompson),  page  170. 

39.  Fruit  Soups,  page  316. 

40.  Grog  de  la  Poiidre  de  Viande  (Dujardin-Beanmetz),  page  490. 

41.  Green  GoosEJiERUT,  Green  Cukrant,  Green   Plum,  or 

Apricot  Fool  (for  the  Diabetic). — These  unripe  fruits, 
before  the  sugar  is  developed  in  them,  may  be  used  by 
diabetics  with  advantage.  They  should  be  stewed  with 
just  sufficient  saccharin  to  give  them  a  pleasant  sweet- 
ness, then  pressed  through  a  sieve  and  a  little  cream  added. 

42.  Gum  Water. — Put  an  ounce  of  best  gum  arabic  and  2  oz. 

of  sugar  into  an  earthen  vessel  with  a  pint  of  water. 
Stand  it  in  a  saucepan  of  boiling  water,  occasionally 
stiiTing  until  dissolved ;  add  the  juice  of  one  lemon.  To 
be  sipped  hot  to  relieve  cough. 

43.  Haricot  Beans,  Directions  for  Cooking  (Sir  H.  Thompson), 

page  296. 

44.  Imperial  Drink  (a  cooling,  diuretic  beverage). — Pour  a  pint 

of  boiling  water  on  a  large  teaspoonful  of  cream  of  tartar, 
a  little  sugar,  and  a  few  pieces  of  lemon-peel.  Strain  when 
cold. 

45.  Inulin  Biscuits  for  Diabetics  (Kultz's),  page -374, 

46.  Junket. — Sweeten   with    white   sugar   one   pint  of    good 

milk.  Add,  if  desired,  a  dessertspoonful  of  sherrj'.  Heat 
to  the  temperature  of  new  milk,  pour  into  a  shallow  di.sli, 
and  stir  in  two  teaspoonfuls  of  essence  of  rennet.     This 


Select  Recipe.':,  569 

will  form  a  slight  curd.  Grate  a  little  nutmeg  over  it, 
and  add  a  pinch  of  powdered  cinnamon.  Serve  when 
quite  cold.  In  cold  weather  the  milk  should  he  pla<ed 
in  a  warm  room  to  set.  A  substitute  for  milk  in  acute 
disease. 

47.  Koumiss  (Home-made). — Boil  fresh  milk,  and  when  nearly 

cold  put  into  quart  bottles,  leaving  room  to  shake.  Add 
^  oz.  of  crushed  lump  sugar  and  a  piece  of  Vienna  yeast 
(20  grains),  cork  with  new  corks,  tie  down,  keep  cool, 
lay  the  bottles  horizontal,  and  shake  twice  daily.  Ready 
to  drink  on  sixth  day,  or  earlier  in  hot,  later  in  cold 
weather.     Can  be  made  thinner  by  using  skimmed  milk. 

48.  Milk  Lemoxade. — Put  a  tablespoonful  of  loaf  sugar,  two 

tablespoonfuls  of  lemon  juice,  and  two  tablespoon fuls  of 
sherry,  into  a  bowl,  and  pour  on  a  cupful  of  boiling 
water.  Stir  till  the  sugar  is  dissolved,  add  half  a  pint  of 
cold  milk,  and  stir  again  till  the  milk  curdles.  Strain 
for  use. 

49.  Lait  de  Poule. — Make  an  emulsion   by  beating  up  the 

yolks  of  two  eggs  with  hot  water,  sweeten  v/ith  sugar, 
and  flavour  with  a  little  orange-flower  water  or  can  de  vie. 

50.  Lemonade  (Pavy). — Pare  the  rind  from  a  lemon  thinly, 

and  cut  the  lemon  into  slices.  Put  the  peel  and  sliced 
lemon  into  a  jug,  with  an  ounce  of  white  sugar,  and 
pour  over  them  a  pint  of  boiling  water.  Cover  the  jug 
closely,  and  when  cold  strain. 

51.  Lemonade. — Rub  two  or  three  lumps  of  sugar  on  the  rind 

of  a  lemon,  express  the  juice,  and  add  three-quarters  of  a 
pint  of  cold  or  iced  water,  or  a  bottle  of  soda-water. 

fi2  Lemonade,  Effervescing. — To  the  expressed  juice  of  a 
large  lemon  add  a  lump  or  two  of  sugar  previously  lightly 
rubbed  on  the  rind.  Pour  on  it  half  a  pint  of  cold  or  iced 
water.  To  cause  it  to  effervesce,  put  it  into  a  large 
tumbler,  and  add  half  a  small  teaspoonful  of  bicarbonate 
of  soda  or  potf.sh. 

63.  Lemox-peel  Tea  (Pavy).  —  Pare  the  rind  thinly  from  a 
lemon  which  has  been  previously  nibbed  with  half  an 
ounce  of  lump  sugar.  Put  the  peelings  and  the  sugar 
into  a  jug,  and  pour  over  them  a  quart  of  boiling  water. 
When  cold,  decant  the  liquid,  and  add  a  tablespoonfid  of 
lemon- juice. 

54.  Lettuce,  Stewed  (especially  for  Diabetics). — Select  a  well- 
grown  lettuce,  and  first  boil  it  in  plenty  of  water,  taking 
caie  not  to  let  it  drop  to  pieces.  When  neai'ly  done  take 
out,  drain,  and  place  in  a  stewpan  with  a  little  rich 
blown  gravy,  and  allow  it  to  siuuner  for  twenty  minutes. 


570  Appendix  III. 

55.  Iiebeg's  Infant's  Food,  pages  243,  251,  537. 

56.  Lime-water,  page  256, 

57.  LiN.sEEn  Tea. — To  a  pint  of  water  add  two  tablespoonfula 

of  linseed,  half  a  lemon,  \  oz.  of  bruised  liquorice  root 
(or  a  piece  of  liquorice  the  size  of  a  filbert),  and  sugar- 
candy  to  taste.     Boil  for  an  hour  and  a  half  and  strain. 

58.  Macaroni  a  L'Italienne  (Sir  Henry  Thomp.son).  —Place  in 

a  quart  stewpan  a  pint  and  a  half  of  boiling  water ;  throw 
in  4  oz.  of  macaroni ;  season  with  salt  and  pepper,  and 
boil  gently  for  twenty  minutes.  Strain  completely  from 
the  water  in  the  colander,  wipe  out  the  stewpan,  and  put 
back  into  it  the  macaroni,  with  a  quarter  of  a  pint  of 
good  stock ;  let  it  simmer  gently  until  all  the  liquid  is 
absorbed  by  the  macaroni,  a  process  requiring  about 
twenty  minutes.  Grate  and  mix  together  an  ounce  of 
Parmesan  and  an  ounce  of  Gruyere  or  good  English 
cheese.  Half  of  this  quantitj'  is  to  be  put  into  the  stew- 
pan, stirring  the  cheese  into  the  macaroni  over  the  fire. 
When  this  quantity  is  dissolved,  add  the  rest  of  the 
cheese,  together  with  rather  more  than  half  an  ounce  of 
butter,  and  stir  until  all  is  melted.  Season  and  serve  on 
a  hot  deep  dish.     Milk  may  be  used  instead  of  stock. 

59.  jMalt  (GKouNn)  and   Rice  Pudding. — Stir  an  ounce  of 

ground  mjilt  into  a  pint  of  boiling  milk ;  strain  through 
a  sieve,  and  add  the  milk  to  2  oz.  of  well-soaked  rice. 
Mix  well,  and  stand  for  ten  minutes  in  a  warm  place; 
then  bake  for  an  hour. 

60.  Meat  Biscuits  (Parke's),  page  184. 
01.  Meat  Solution  (Lcube's),  page  543. 

62.  Meat  Tea  (Bartholow).— Put  one  pound  each  of  beef, 

mutton,  and  veal,  cut  into  small  pieces,  into  three  pints 
of  cold  water.  It  should  simmer  for  three  or  four  hours, 
but  not  boil.  When  finished,  the  tea  should  be  carefully 
strained,  and  seasoned  with  salt,  and  cayenne  pepper  if 
preferred. 

63.  Milk  Soup.  — Boil  a  pint  of  milk  wilh  a  little  shredded 

onion,  celery,  parsley,  or  other  flavouring  vegetable. 
Strain  and  serve  wilh  fragments  of  toasted  bread. 

64.  Milk  and  Suet  (Pavy). — Boil  an  ounce  of  finely-chopped 

suet  with  a  quarter  of  a  pint  of  water  for  ten  minutes, 
and  press  through  linen.  Then  add  a  dram  of  bruised 
cinnamon,  an  ounce  of  sugar,  and  three-quarters  of  a  pint 
of  milk.  Boil  again  for  ten  minutes,  and  strain.  A 
wine-glassful  or  two  at  a  time.     Nutritive  and  fattening. 


Select  Hecipes.  571 

66.  Mutton  Broth  (Bartholow).— Boil  one  pound  of  lean  loin 
of  mutton,  exclusive  of  hone,  with  three  pints  of  water, 
till  tender,  throwing  in  a  little  salt  and  onion  according 
to  taste.  Pour  out  the  hroth  into  a  hasin,  and  when  it 
is  cold  skim  ofE  the  fat.    It  can  he  warmed  up  as  wanted. 

66.  Mutton  and  Chicken  Buoth. — Mince  a  pound  of  either 

chicken  or  mutton,  fieed  from  fat,  put  into  a  pint  of  cold 
water,  and  let  it  stand  in  a  cold  jar  or  ice  two  to  three 
hours.  Then  cook  three  hours  over  a  slow  lire,  strain, 
cool,  skim  off  fat,  add  salt,  and  servo  hot  or  cold. 

67.  Mutton  Broth. — Put  2  or  3  Ihs.  of  neck  of  mntfon  into 

a  stewpan,  pour  over  it  two  pints  of  water,  add  pepper 
and  salt.  When  it  boils,  skim  carefully.  Cover  the  pan 
and  let  it  simmer  gently  for  an  hour.  Strain  it,  let  it  get 
cold,  and  then  remove  all  the  fat.  When  required  for 
use,  add  some  pearl  harley,  or  potatoes,  in  the  following 
manner.  Boil  ^  lb.  of  potatoes,  mash  them  smoothly,  so 
that  no  lumps  remain.  Put  the  potiitoes  into  a  pan, 
and  gradually  add  the  mutton  broth,  stirring  it  till  it  is 
well  mixed  and  smooth ;  let  it  simmer  for  five  minutes, 
and  serve  with  fried  bread. 

68.  Oatmeal  Gruel. — Mix  thoroughly  one  tablespoonful  of 

groats  with  two  of  cold  water;  add  to  this  a  pint  of 
boiling  water,  stirring  constantly.  Boil  and  stir  for  ten 
minutes.     Sweeten  with  sugar. 

69.  Oatmeal  Gruel  (Another). — Take  two  tablespoonfuls  of 

oatmeal,  one  saltspoonful  of  salt,  one  small  toaspoonful  of 
sugar,  one  large  cupful  of  boiling  water  and  one  of  milk. 
Mix  the  oatmeal,  salt,  and  sugar  together,  and  pour  on 
the  boiling  water.  Cook  for  thirty  minutes,  then  strain 
with  a  fine  wire  strainer  to  remove  the  husks,  place  again 
on  the  stove,  add  the  milk,  and  heat  just  to  the  boiling 
point.     Serve  hot. 

70.  Oatmeal  Porridge. — To  a  pint  of  boiling  water  add  half 

a  toaspoonful  of  salt,  and  sprinkle  slowly  in  three  to  four 
ounces  of  oatmeal  till  of  stifiicient  thickness,  keeping 
it  stirred  with  a  ponidge-stick.  Boil  gently  for  fifteen 
to  twenty  minutes  ;  add  a  little  more  boiling  water,  and 
boil  for  five  minutes  more.  It  may  be  served  with  milk, 
cream,  butter,  sugar,  etc. 

71.  Oatmeal  Porridoe  with   Milk.— Into  an  enamel-lined 

saucepan  put  a  quart  of  milk.  When  on  the  point  of 
boiling,  stir  in  slowly  ;^  lb.  of  coarse  oatmeal,  and  con- 
tinue f^tining  as  it  thickens.  Let  it  boil  for  about  twenty 
minutes.  It  can  be  made  thicker  or  thinner  as  desired, 
and  served  with  cream,  salt,  sugar,  or  other  addition. 


572  Appendix  III. 

72.  Oatmeal  Soup  (Bartholow). — Put  2  oz.  of  oatmeal  in  a 

basin  ;  pour  over  it  a  pint  of  cold  water,  stir  it,  and  let  it 
stand  a  minute ;  then  pour  over  it,  quickly  stirring  aU 
the  time,  a  pint  of  good  broth ;  pour  through  a  fine 
strainer  into  a  saucepan,  taking  care  that  none  of  the 
coarse  part  of  the  meal  goes  into  the  soup.  Boil  the  soup 
for  ten  minutes,  season,  and  serve. 

73.  OjtGEAT  (Pavy).    {A  demulcent  and  nntrWxve  drink.) — Blanch 

2  oz.  of  sweet  almonds  and  four  bitter  almond  seeds. 
Pound  them  into  a  paste  with  a  little  orange-flower 
water,  rub  this  with  a  pint  of  milk  diluted  wilh  a  pint 
of  water  until  it  forms  an  emulsion.  Strain  and  sweeten 
with  sugar. 

74.  Oyster  Buoth. — Take  six   or  eight   fresh   oysters,  chop 

them  small,  put  them  with  their  liquor  into  an  enamelled 
saucepan,  pour  over  them  a  cupful  of  cold  milk,  and  bring 
the  liquid  slowly  to  the  point  of  boiling.  Simmer  for  a 
minute  or  two,  strain  through  a  fine  sieve,  season  with 
salt  and  white  pepper,  add  a  teaspoonful  of  cream,  and 
serve. 

75.  Peptonised  Beef- Tea,  page  543. 

76.  Peptonised   Enema  (EwmW). — Boil  a  pinch  of  flour  in 

half  a  cupful  of  a  20  per  cent,  folution  of  glucose.  Mix 
in  three  whipped  eggs,  a  glass  of  red  wine,  and  a  tea- 
spoonful  of  peptone. 

77.  Peptonised  Milk,  page  464. 

78.  Peptonised  Milk-Gruel,  page  542, 

79.  Port  Wine  Jelly. — Put  one  ounce  of  isinglass  into  a 

quarter  of  a  pint  of  water,  and  set  on  the  fire  till  the 
isinglass  is  dissolved.  Then  add  1  oz.  of  sugar  and  a  pint 
of  port.  Strain  through  muslin  into  a  mould,  and  let 
it  set. 

80.  Powdered  Meat  (Dujardin-Beaumetz). — Take  cold  boiled 

meat,  mince  it  fine,  dry  it  in  a  water-bath  {bain-marie), 
and  reduce  to  powder  in  a  coffee-mill. 

81.  Powdered  Meat  Punch  (Dujardin-Beaumetz). — Place  in 

a  bowl  two  tablespoonfuls  of  powdered  meat,  three  table- 
spoonfuls  of  syrup  of  punch,  and  sufficient  milk  to  make 
a  very  fluid  mixture. 

82.  Paw   Meat   (Ringer). — Cut  into   small  squares   2   oz.  of 

rump-steak  free  from  fat,  without  entirely  separating  the 
meat ;  pound  in  a  mortar  for  five  or  ten  minutes ;  add 
three  or  four  tablespoonfuls  of  water,  and  pound  again 
for  a  short  time ;  then  remove  all  sinew  or  fibre  of  the 
meat,  leaving  oi^y  the  creamy  substance;  add  salt  to 
taste.  ^. 


Select  Recipes.  573 

Before  using,  place  the  cup  or  jar  containing  the 
powdered  meat  in  hot  water  until  just  warm. 

May  be  made  into  sandwiches  with  thin  bread-and- 
butter.     Useful  in  chronic  diarrhoea. 

83.  Raw    Meat    with    Milk   and   Sugar   (Ringer). — Scrape 

with  a  knife  hulf  ii  pound  of  rump-steak  until  all  the 
pulp  is  removed  from  it ;  sweeten  with  sugar,  breaking 
the  lumps  of  sugar  with  the  meat  in  a  basin  with  a  smdil 
wooden  spoon.  Add  slowly  as  much  milk  as  will  make 
it  the  thickness  of  an-owroot ;  flavour  with  brandy. 
Strain  through  a  gravy  strainer  if  there  is  any  fibre  of 
the  meat  in  it,  as  the  mixture  should  be  perfectly  smooth. 

84.  Raw  Meat  with   Fkuit  Jelly  (Adrian). — Mix  2  oz.  of 

pulp  of  fillet  of  beef  (made  by  scraping  with  a  knife) 
and  15  grs.  of  common  salt  with  1  lb.  of  fruit  jelly  of 
any  kind. 

85.  Raw^  Meat  in  Emulsion  (Yvon). — Take  2  oz.  of  pulp  of 

raw  meat,  A  oz.  of  blanched  sweet  almonds,  about  half 
one  bitter  almond,  and  ^  o/..  white  sugar.  Pound  them 
together  in  a  marble  mortar,  and  add  enough  water  to 
make  an  emulsion. 

86.  Raw  Meat  Juice  (Cheadle). — Add  to  finely-minced  rump- 

steak  cold  water,  in  the  proportion  of  one  part  of  water 
to  four  of  meat.  Stir  well  together,  and.allovv  to  stand 
for  half  an  hour.  Forcibly  express  the  juice  thiough 
muslin  by  twisting  it. 

This  contains,  per  cent. : — Albuminate  5"1,  nitrogenous 
extractive  3'1,  salts  0*7. 

Dr.  Cheadle  calls  this  "the  most  easily-digested  and 
most  restorative  of  all  animal  foods ;  the  most  valuable  of 
all  nitrogenous  preparations  for  children." 

It  mixes  well  with  milk,  and  it  is  highlj'  anti-scorbutic. 
It  does  not  keep  well,  and  must  be  made  fresh. 

87.  Raw    Meat    Sandwiches. — Take   3   oz.   of  raw  beef  or 

mutton,  1  oz.  of  very  fine  bread-crumbs,  one  teaspoonf  ul 
of  sugar ;  cut  the  meat  very  fine  so  as  to  be  able  to  rub 
it  through  a  hair  sieve,  then  pound  it  in  a  mortar  into  a 
paste.  Mix  with  it  the  brc;id-crumbs,  sugar,  a  little  salt 
and  pepper;  spread  it  between  thin  slices  of  cither  brown 
or  white  bread  and  butter. 

88.  Raw   Meat  and   Tai-ioca   Sour    (Dujardin-Beaumetz). — 

Take  1  oz.  of  raw-meat  pulp,  made  by  scraping  meat 
(preferably  mutton)  into  a  fine  pulp  with  a  knife,  mix  it 
with  half  a  pint  of  tapioca  soup  (No.  101). 

89.  Raw  Soup  (Weir  Mitcholl's),  page  468. 


574  AppendjX  111. 

90.  Reb  or  Black  Cuiuiant  Drink  with  Aiikdweoot. — Boil 

two  table-spoonfuls  of  red  or  black  currant  jam  in  a  quart 
of  water ;  let  it  simmer  for  half  an  hour,  strain,  and  re- 
place on  fire  to  keep  boiling.  Mix  a  teaspoonf ul of  arrow- 
root in  cold  water,  and  pour  the  boilin<^  fluid  on  it,  and 
keep  stirring  until  uniformly  mixed.  May  be  cooled  by 
standing  on  ice. 

91.  Rice  Cream. — Cleanse  two  tablespoonfuls  of  rice  by  wash- 

ing it  several  times  in  cold  water ;  cook  it  in  a  double 
boiler  with  two  large  cups  of  milk  until  the  grains  will 
mash.  Three  hours  will  generally  be  required  to  do  this. 
Replace  by  fresh  milk  that  lost  by  evaporation.  When 
the  rice  is  perfectly  soft,  press  it  througli  a  coarse  soup 
strainer  or  colander  into  a  saucepan,  return  it  to  the  fire, 
and  while  it  is  heating  beat  two  eggs,  two  tablespoonfuls 
of  sugar  and  one  saltspoonful  of  salt  together  until  very 
light.  "When  the  rice  boils,  pour  this  mixture  in  rather 
slowly,  stirring  lightly  with  a  spoon  for  three  or  four 
minutes,  or  until  it  coagulates,  and  the  whole  is  like  a 
thick  soft  pudding ;  then  remove  from  the  fire,  and  pour 
it  into  a  dish.  By  omitting  the  yolks  and  using  the 
whites  of  the  eggs  only,  a  delicate  cream  is  obtained. 

92.  Rice  Milk. — Soak  1  oz.  of  rice  for  twelve  hours,  wash  it 

quite  clean,  and  drain  it.  Add  the  soalced  rice  to  a  pint 
of  boiling  milk,  with  half  a  teaspoonful  of  salt  and  of 
sugar.  Stir  well,  and  cook  slowly  for  an  hour.  Rub 
through  a  hair  sieve.  (Sago  or  tajjioca  may  be  substituted 
for  rice.) 

93.  Rice  PunniNC. — Soak  2  oz.  of  rice  in  two  waters,  for  six 

houi-s  each ;  add  it  to  a  ])int  of  milk,  and  boil  and  stir 
till  it  thickens.  Remove  from  fire,  and  mix  well  in  2  oz. 
of  butter,  a  little  gi'atcd  nutmeg  (or  lemon-peel),  and 
sugar.     Cool,  and  then  bake  in  a  suitable  buttered  dish. 

94.  Rice  Soup. — Soak  \  oz.  of  Patna  rice  for  ten  hours.    Then 

stir  it  with  boiling  water  for  five  minutes.  Remove  it 
into  cold  water,  drain  it,  and  stir  it  into  a  pint  of  boiling 
stock.  Simmer  in  saucepan  (not  completely  covered)  for 
two  hours.  Season  with  stilt,  add  the  beaten-up  yolks  of 
two  eggs,  and  serve  hot. 

95.  Rice  Watkr  (Pavy).  {^A  useful  drink  in  dysente^-y,  diarrhoea, 

etc.) — "Wash  well  1  oz.  of  Carolina  rice  with  cold  water. 
Tlien  macerate  for  three  hours  in  a  quart  of  water  kept 
at  a  tepid  heat,  and  afterwards  boil  slowly  for  an  hour, 
and  strain.  May  be  flavoured  with  lemon-peel,  cloves,  or 
other  spice. 

96.  Sago  (Bartholow). — Put  \  oz.  of  sago  into  an  enamelled 

saucepan,  with  thiee-quarters  of  a  pint  of  cold  water,  and 


Select  Recipes.  575 

boil  gently  for  an  hour  and  a  quarter.  Skim  when  it 
comes  to  a  boil,  and  stir  frequently.  Sweeten  with  a 
dessertspoonful  of  sifted  loaf  sugar.  A  tablespoonful  of 
wine,  or  a  dessertspoonful  of  bi'andy,  may  be  added. 

97.  Soup  (Prison  Diets),  page  213. 

98.  Stirabout  (Prison  Diets),  page  214. 

09.  SuccLs  Carnis  [Meat  Juice)  Recenter  Expressus  (Petten- 
kofer  and  Voit). — Meat  is  cut  up  small,  arranged  in 
layers  separated  from  one  another  by  coarse  linen,  and 
then  placed  in  a  powerful  press.  From  each  Vilogi'amme 
of  meat  about  230  grammes  of  a  blood-red  auiJ  juice  are 
obtained.  It  contains  about  6  per  cent,  of  albuminates. 
It  tastes  like  luw  meat ;  its  flavour  may  be  improved  by 
the  addition  of  salt,  and  beef-tea  not  hot  enough  to 
coagulate  the  albumen. 

100.  Tapioca  Jelly  (Bartholow). — Soak  a  cup  of  best  tapioca 
with  a  pint  of  cold  water  ;  when  soft  put  into  a  saucepan 
with  some  sugar,  the  rind  and  juice  of  one  lemon,  a  little 
salt,  one  pint  more  water ;  stir  until  it  boils ;  turn  into  a 
mould  ;  set  to  cool ;  add  one  glass  of  wine  if  desired. 

101.  Tapioca  Soup. — Boil  a  pint  of  meat  broth  or  stock,  and 

while  kept  constantly  stirred,  spiinkle  in  \  oz.  of  pre- 
viously-washed tapioca.  Cover  the  saucepan,  and  let  it 
sinuner  till  the  tapioca  is  quite  soft.     Skim  and  serve. 

102.  Toast  Water. — Take  a  slice  of  stale  bread — crust  is  to  be 
preferred — and  toast  it  slowlj'  all  through  without  burning 
it.  Let  it  go  cold,  and  then  pour  over  it  a  quart  of  boiling 
water,  and  let  it  stand  covered  till  cold.  Strain  it  through 
muslin  before  serving  it. 

103.  Treacle  Posset.  (A  diaphoretic  drink  for  a  cold.) — To 
two  or  three  tablespoonf  uls  of  treacle  add  a  pint  of  boiling 
milk.     Boil  up  well,  and  strain. 

104.  Veal  Broth. — Cut  a  pound  of  knuckle  of  veal  into  small 

pieces,  place  these  in  a  stewpan  with  three  pints  of  water 
and  two  tablcspoonfuls  of  rice.  Boil  very  gently  for  an 
hour  and  a  half,  or  longer.  For  flavouring,  a  few^  parsley 
leaves,  a  sprig  ol  thyme,  and  a  lettuce  leaf  may  be  chopped 
small  and  simmered  with  the  veal  for  five  or  six  minutes 
— or  a  small  blade  of  mace,  a  sprig  or  two  of  parsley,  and 
one  of  thyme  and  marjoram,  can  be  used. 

105.  Vegetahi.e  Sows  fok  the  Diahetic. — To  a  weak  moat  or 
bone  stock  add  a  tine  puree  of  either  of  the  following 
vegetables  :  spinach,  turnip,  tomato,  sorrel,  lettuce,  or 
asparagus ;  and  to  this  a  certain  amount  of  cream  may  bo 
added  if  the  >^<"*ient  can  digest  it  w^ell. 


576  Appendix  III. 

106.  Vermicelli  Milk  Soup. — Into  a  quart  of  boiling  milk 
put  a  level  saltspoonful  of  salt  (or  celery  salt)  ;  add  slowly 
(stirring  constantly)  2  oz.  of  vermicelli ;  keep  stirring  for 
fifteen  or  twenty  minutes,  until  quite  soft.  The  yolks  of 
two  eggs  should  be  added  when  the  soup  is  ready  to  be 
removed  from  the  fire.  This  soup  may  also  be  flavoured 
with  cinnamon  and  sugar. 

107.  Whey  (Lemon),  page  310. 

108.  Whey  (Louis  Starr's),  page  257. 

109.  Whey  made  avith  Cream  or  Tartar. — Mix  a  large  tea- 
spoonful  of  cream  of  tartar  with  two  tablespoonfuls  of 
hot  water,  and  add  this  to  a  pint  of  boiling  milk.  Add  a 
little  sugar  and  lemon-peel.  Let  it  stand  till  cold,  and 
then  strain. 

110.  Whey  (Sweet). — To  a  pint  of  milk  add  about  a  square 
inch  of  rennet,  and  slowly  warm  to  about  100°  Fahr. 
Stand  for  thirty  minutes  in  a  warm  place,  and  then  strain 
through  muslin. 

111.  White  ok  Egg,  Solution  of. — Diffuse  the  whites  of  two 

eggs  through  a  pint  and  a  half  of  water.  Sweeten  to  taste, 
and  add  a  little  cognac  or  other  liqueur  if  necessary. 

112.  White  Wine  Whey. — Add  two  wine-glassfuls  of  sherry 
to  a  pint  of  boiling  milk  and  strain  through  a  fine  sieve, 
and  sweeten  with  sifted  sugar. 


INDEX. 


Note. — The  French  "gramme,"  used  in  the  Text,  is  equal  to  15*432  grains 
(roughly  15  grains),  and  28-3495  grammes  are  equal  to  1  02.  avoir.  The 
"  litre,"  as  a  fluid  m.easv.re,  is-tqiial  to  35  oz.,  or  IJ  imperial  pint. 


Abdominal  plethora,    Grapo    cure 

in,  533 
Absintlie,  116 
Acids  in  fruits,  93 

in  wines,  118,  122 

Acne,  Diet  in,  510 

Acute  disease.  Food  in,  300 

gastric  catarrh.  Food  in,  328 

nepliritis,  Milk  diet  in,  414 

Adult  life,  Food  in,  27() 
Adulteration  of  wines,  123 
Advanced  life,  Food  in,  284 
Aerated  bread,  107 
Age  and  condition,  Food  in  relation 

to,  203,  240 
Albumen,  6 

,  Circulating,  14 

,  Organic,  14 

,  Vegetable,  66 

Albuminates,  Class  of,  6 

,  Composition  of  tlie,  7 

,  Effects  of  excess  of,  20 

,  Functions  of  the,  13,  16 

Albuminuria,  Diet  in,  405,  417-420 

from  eating  eggs,  406,  409 

ft-om  food,  406-410 

,  Milk  diet  in,  417 

Albnmose,  136 

Alcohol  a  cause  of  gastric  catarrh, 

829,  832 

in  acute  disease,  318 

— — pneumonia,  503,  504 

in  asthma,  507 

in  cardiac  dyspepsia,  495 

in  diabetes,  3S9 

,  its  effects  ou  the  organism, 

109-113 
,  its  varying  action  on  different 

individuals.  111 
Alcoholic  beverages,  109 

in  gout,  431 

in  phthisis,  487,  488 

stimulants    in   neurasthenia, 

469 

strength  of  wines,  121 

Alcohols,  115 

Aleuronat  bread  in  diabetes,  389, 391 

Alimentary  principles,  5 

substances,  31 

Alimentation  forcee,  489 
— -,  Rectal.  544 

L  L 


Alkaline  phosphates  of  sodium  and 
potassium,  26 

table  waters,  Value  of,  124 

waters  in  diabetes,  370,  387 

in  gout,  430 

Allen  and  Hanburys'  Infant's  Food, 
243,  538 

Almond  biscuits  and  pudding  for 
diabetics,  564 

cakes  for  diabetics,  383 

Alum  whey,  56,  564 

American  bouillon,  566 

Amylic  alcohol  (fusel  oil),  115 

Amylopsin,  143 

Anaemia,  Causes  of,  460 

,  Excessive  excretion  of  nrea 

in,  462 

in  infants,  465 

in  young  girls  caused  by  in- 
sufficient food,  272 

,  Skimmed  milk  in,  463 

with  obesity,  442 

Aneurysm,  Diet  in,  501 

Animal  and  vegetable  foods  com- 
pared, 290 

,  Difference  in  com- 
position of,  66 

food.  Composition  of,  33 

,  Effects  of,  290,  291 

in  anftemia,  465 

^—  in  gout  and  uriccemia, 

425,  426 

foods,  32 

,  Digestibility  of,  141 

Animals,  Effect  of  different  kinds 
of  food  on,  290,  291 

Anisette,  116 

Annaeff's  koumiss  cure,     4,  530 

Annexation  of  food,  132 

Anti-rheumatic  effects  of  celery,  87 

Antiscorbutic  properties  of  fresh 
fruits,  92 

Antiscorbutics,  177,  178 

Antisepsis,  intestinal.  Necessity  for 
maintaining,  in  fevers,  321 

Antiseptic  action  of  bile,  145 

agents  for  preserving  food,  180 

Aphrodisiac  effect  of  fish  diet,  43 

Apoplexy,  Feeding  and  diet  in,  517 

Appert's  process  for  preserving 
foods,  179 


578 


Food  in  Health  and  Disease 


Apples,  91,  93 

Arctic  regions,  Diet  in,  294 

Argol,  119 

Armies,  European,  Meat  ration  of, 
226-231 

Aroma  of  wines,  118,  122 

Arrack,  115 

Arrowroot,  83,  564 

,  Red  or  black  currant  drink 

with,  574 

Aj-terio-sclerosis,  Diet  in,  497 

Artichoke,  Green,  87 

,  Jerusalem,  83 

Artificial  digestive  agents  and  arti- 
ficial alimentation,  535 

human  milk,  255 

peptones,  138 

suralimentation,  489 

Aseptin,  181 

amykos,  181 

Ash  of  animal  foods,  Composition 
of,  65 

Ashby  and  Wright  on  infant-feed- 
ing, 262 

Asparagin,  67 

Asparagus,  87 

Ass's,  cow's,  and  human  milk  com- 
pared, 248 

milk,  246 

^^ ,  Composition  of,  60 

Assimilability  of  animal  and  vege- 
table foods,  149 

Assimilation  of  food,  182,  147 

Asthma,  Diet  in,  606 

Attfleld's  analysis  of  soya  bean- 
flour,  384 

Austrian  soldier's  rations,  229 

Average  daily  diets,  187-206 

diet  for  very  laborious 

work,  194 

requirements  of  alimentary 

principles,  187 

Avenin,  74 


Bacillas  acidi  lactici,  47 
Bacon,  Properties  of,  37,  180 
Bacteria,  Putrefactive,  in  alimen- 
tary canal,  144 
Baked  meat.  Objections  to,  162 
Baking  powders,  165,  166,  171 
Balfour,  Dr.,  on  diet  in  senile  heart, 

498-500 
Banting's  cure  for  obesity,  443 
Barley  and  rice  water  in  fevers,  316 

,  Composition  and  properties 

of,  70,  73,  77 

jelly,  259 

water,  564 

Barsac,  123 

Batatas  edulis,  82 

Bauer  and  Kanstle  on  the  diet  of 

typhoid  patients,  306 
t—  on  alcohol,  110 
— —  on  beef-tea  in  fevers,  812 


Bauer  and  Kunstle  on  the  functions 

of  the  carbohydrates,  21 
Beans,  79 

,  Mode  of  cooking,  174 

Beclard,  Jules,  on  vegetarianism, 

293 
Beef  cakes,  458 

,  Composition  of,  33,  34 

essence,  565 

for  gastric  catarrh,  331 

juice,  565 

in  phthisis,  486 

peptone,  640 

-tea,  565 

,  Bauer  on,  312 

,  Dujardin-Beaumetz  on, 

313 

,  G.  S6e  on,  312 

,  Peptonised,  543 

,  Value  of,  in  fevers,  312 

with  oatmeal,  566 

Beer,  126 

,  A  cheap  substitute  for,  180 

,  Composition  of,  127 

in  febrile  diseases,  319 

,  its  influence  on  digestion,  129 

,  Properties  of,  129 

,  Varieties  of,  128 

Beers,  Amount  of  alcohol  in,  128 

,  German,  Analysis  of,  127 

Beetroot,  85 

Benedictine,  116 

Beneke's  dietary  for  treatment  of 

cancer,  299,  620 
Benger's  food,  243,  541 

liquor  pepticus,  539 

pancreaticus,  541 

peptonising  powders,  541 

Bernard,  C,  on  glycosuria,  364 
Beverages,  96 

,  Alcoholic,  109 

for  the  gouty,  429 

in  affections  of  the  circulator}' 

organs,  494-498 

in  fevers,  314 

in  obesity,  449 

Biedert's  cream  mixture,  262 

Bilberries,  93 

Bile,  its  functions,  145 

,  its  influence  in  the  digestion 

of  fats,  145,  146 
Biliary  concretions,  Diet  in,  432 
Bilious  attacks  from  over-feeding, 

277 
Biscuits,    Advantages   and   disad- 
vantages of,  171,  172 

,  Almond,  for  diabetics,  564 

,  Meat,  184 

Black  tea,  99,  100 

Bleeding  before  slaughtering,  84 

BIoo<l  as  food,  38 

fibrin,  7 

Bodily   Income    and    expenditure 

according  to  Landois,  190,  191 
income  and  output,  187 


Index. 


579 


Body,  Composition  of  the  human,  5 
Boiling,  Effects  of,  156 
— — ,  its  effect  on  water,  97 

milk,  Changes  induced  by,  558 

,  Modes  of,  157 

Bones,  Nutritive  value  of,  37 

Bordeaux  wines,  123 

Boric  acid  for  preserving  food,  181 

Boroglyceride,  181 

Bouchard's  diet  for  dilatation  of 

the  stomach,  345 
Boucliardat's  dietary  in  diabetes, 

399 
Bouillon,  156,  566 

,  American,  566 

Bouquet  of  wines,  119,  122 
Brain,  its  food  value,  38 

workers,  Diet  suitable  for,  282 

Braising,  161 

Bran,  71 

— —  bread  and  cakes  for  diabetics, 

381 

in  bread,  Indigestibility  of,  169 

Brandy,  114 

and  egg  mixture,  311 

Bread,  Aerated,  167 

badly    made    a    cause    of 

dyspepsia,  167 

,     digestibility    of     difl'erent 

kinds,  167, 168 

• for  diabetics,  381 

in  dyspepsia,  349 

jelly,  566 

• for  infants,  263 

,  Leavened,  165 

made  of  dried  fish,  41 

making,  165 

,  Different  metliods   of, 

165 

of  Iceland  moss  for  diabetics, 

375 

,  Preserved,  177 

,  Whole-meal,  170 

, ,  in  prisons,  213 

Breakfast,  Proper  time  for,  233 
Bright's  Disease,  Chronic,  406 

'-,  Diet  in,  417-420 

Brill,  41 

Brine,  Constituents  in,  180 
Bristowe  on  glycosuria,  370 
Broadbent,  Sir  W.,  on  hot  water  in 

dilation  of  stomach,  346 
Broccoli,  87 
Broiling,  162 
Bronchial  catarrh.  Whey  cure  in, 

528 
Bronchitis,  acute.  Diet  in,  505 
Broncho-pneumonia,    Alcohol    in, 

505 
Broth  made  by  cold  infusion,  158 

or  bouillon,  157 

Buckwheat,  Composition  of,  78 
Budin's  method  of  sterilising  milk, 

563 
Burgundy  wines,  121, 123 


Burnett's,  Colonel,  diets   for  sol- 
diers, 222,  224 
Butter,  Composition  of,  47,  59 

,  Preservation  of,  60, 182 

milk     in     chronic     gastric 

catarrh,  335 

,  its  composition,  56 

Butylic  alcohol,  115 

Cabbage,  Dried,  177 

tribe  (Cruciferce),  85  -^ 

Cacao  butter,  107 

Cafe  uoir,  106 

Caffein,  98,  104 

Cakes,  Almond,  for  diabetics,  383 

Calcium  and  magnesium  phos- 
phates, 26 

-—  carbonate  in  the  tissues,  25 

phosphate  in  the  tissues,  25 

Calculation  of  Diets,  Tables  for, 
195-201 

Calculous  disorders.  Diet  in,  421 

Camplin's  bran  cakes,  381 

Cancer,  Beneke's  dietary  for,  299, 
520 

caused  by  excess  of  animal 

food  (?),  299,  520 

of  stomach,  Dietetic  treat- 
ment of,  340 

Cane-sugar,  68,  95 
Cantani's  diet  for  gout,  437 

-  dietary  in  diabetes,  400 
Carbohydrates,  Class  of,  88 

,  Functions  of,  21 

,  their  conversion  into  fat, 

22,24 

,  their   conversion   into 

glucose,  etc.,  22 

Carbon,  Quantities  of  foods  re- 
quired to  supply  the  necessary, 
205 

Cardiac  valvular  disease.  Diet  in, 
494-497 

Caricin  or  papain,  143 

Carlo  witz,  123 

Carlsbad  course  in  chronic  gastric 
catarrh,  337 

Carnick's  soluble  infant's  food,  541 

Carrot,  84 

Casein,  7 

,  Vegetable,  67 

Cathcart's  method  of  sterilising 
milk,  559 

Caudle,  567 

Cauliflower,  87 

Causation  of  glycosuria,  365 

Caviare,  42 

for  diabetics,  385 

Celery,  An  anti-rheumatic,  87 

Cellular  tissues,  their  agency  in 
nutrition,  18 

Cellulose,  8,  68 

,  Indigestibility  of,  150 

Cerealia,  I'he,  69 

Cerealin,  71,  243 


S8o 


Food  in  Health  and  Disease. 


Certain  special  dietetic  cures,  523 

Chablis,  121,  123 

Chalfont,  Epileptic  colony  at,  daily 

dietary,  519 
Champagne,  121, 124 
Chapman's  entlrevjvlieat  flour,  243 
Charqui,  176  \ 

Chartreuse,  110 
ChS.teau  d'yquera,  119 

Lafitte,  121 

Margaux,  121 

Chaumont,  Dr.  de,  on  prison  diets, 

219 
Cheese,  CO 

cakes  for  diabetics,  507 

,  Composition  of,  61 

,  Digestibility  of,  02 

,  Fermentative  processes  in,  CO 

,  Varieties  of,  61 

Cherries,  92 
Cliicken  broth,  507 

panada,  567 

Chicory,  108 

Children,  Meal  times  of,  237 

,  young,  Dietary  of,  200 

China  and  Indian  teas,  100 
Chittenden,    Prof.,    on    digestive 

ferments,  539 
Chocolate,  107 
Chondrin,  7 
Chorea,  Diet  in,  519 

Chronic  febrile  conditions.  Diet  in, 

478 
^■^  gastric  catarrh,  Dietetic  treat- 
ment of,  332-337 

parenchymatous     nephritis, 

Milk  diet  in,  414 
Chyle,  148 
Chyme,  136 

Cider  and  perry,  125 

in  gout,  431 

Circulating  albumen,  14 

Circulatory  organs,  Diet  in  affec- 
tions of  the,  494 

Circumstances  which  retard  gastric 
digestion,  142 

Clarets  or  Bordeaux  wines,  122,  123 

Classification  of  food,  0-9 

of  wines,  122, 123 

Climate,  Influence  of,  on  obesity,  441 

, ,  on  diet,  2S2 

Clotted  cream,  55 

Coagulation  of  milk,  52 

Coca,  108 

Cocoa  in  prison  diet,  214 

or  cacao,  100 

and  milk,  Peptonised,  485 

Cod,  41 

Cofl"ee  after  dinner,  239 

,  Composition  of,  103,  104 

in  asthma,  507 

^^  in  dyspepsia,  351 

in  typhoid,  323 

,  its  influence  on  digestion.  Sir 

W.  Roberts's  observations  on,  106 


Cofi'ee  jelly,  567 

,  Properties  and  preparations 

of,  104,  105 

,  Toxic  effects  of,  105 

Cognac,  114,  115 

Cold  as  a  preservative  of  food,  179 

Colostrum,  50,  242 

Commercial  peptones,  13S 

Committee,  Parliamentary,  on  sol- 
diers' dietary,  ReiJort  of,  222 

Common  salt,  its  importance  in 
food,  25,  130 

,  its  influence  on  excretion 

of  urea,  27 

Complete  foods  (milk  and  eggs),  46 

Composition  of  human  body,  5 

Concentration  of  food,  230  " 

,  how  far  possible,  231 

Condensed  milk,  54,  249,  250 

Condiments,  130 

and  stimulants,  their  uses,  29 

Constipation,  chronic,  Dietetic 
treatment  of,  357 

from  milk  diet,  413 

Consumption,  pulmonary.  Food  in, 
480.     (See  also  Phthisis) 

Continental  system  of  feeding,  235 

Convalescence,  Diet  in,  319,  320 

Cooked  and  raw  fruits,  93 

Cooking,  Objects  and  effects  of,  155 

offish,  164 

of  vegetable  foods,  164 

. ,  preparation,  and  preservation 

of  food,  155-184 

Cornflour  or  maizena,  76 

Correctional  diets,  214 

Couscousou,  73 

Cow's,  ass's,  and  human  milk  com- 
pared, 248 

milk.  Circumstances  influenc- 
ing its  composition,  etc.,  50 

,  Composition  of,  46,  49 

Crab,  44 

Crawfish,  44 

Cream,  55 

,  Clotted,  or  Devonshire,  55 

mixture,  Biedert'.s,  262 

in  ansemia,  403 

in  phthisis,  482 

of  tartar,  119 

,  Rice,  574 

Creamometer,  53 

Cress,  88 

Crustacea  and  mollusca,  43 

Cucumber,  88 

Curagoa,  116 

Curd  and  whey,  55 

Cures  for  obesity,  442 

,  Banting's,  443 

- — ,  Danccl's,  442 

,  Dry,  442 

,  Ebstein's,  443 

,  Oertel's,  444 

,  Salisbury,  451,  455 

,  Schweninger's,  445 


LXDEX. 


581 


Currant,  Red  or  black,  drink,  574 
Currants,  91,  93 

Dates,  94 

DauglisU's  process  of  bread-making, 

166,  167 
D^bove  on  raw  meat  in  phthisis, 

490 

—  on  sui-alimeutation  in  phthisis, 
4S9     . 

Decorticated  whole-wheat  meal,  73 
Defective     feeding    a    cause     of 

anaemia,  chlorosis,  etc.,  460 
Defects  in  prison  diets,  219 
Deficient  diet.  Effects  of,  203 
Dejeuner  k  la  fourchette,  235 
Denis-Dumont  on  cider,  126 
Desiccated  milk,  1S2,  465 
Devonshire  cream,  55 
Dextrin,  9,  71 
Diabetes,  Alkaline  waters  in,  370, 

871,  3S6 
,  Dietetic   treatment  of,  363, 

373 

,  Fat  in,  384,  390 

,  Formation  of  sugar  in,  364 

,  Pavy  on,  368 

■^— ,  Von  Noorden's  diet  in,  376, 

3SS-395 
Diabetic  dietaries,  377-404 
Diabetics,    Almond    biscuits    and 

puddings  for,  504 

, cakes  for,  383 

,  Classification  of,  370 

Diarrhoea,   chronic,   Koumiss    for, 

362 

, ,  Raw  meat  in,  360 

,  Dietetic  treatment  of,  359 

in  infants,  Causes  and  remedy, 

361 
Diastase,  126,  535 
Diet,     Average    daily,    Dujardin- 

Beaumetz's,  203 
, ,  for  very  laborious 

work,  193 

, ,  Moleschott's,  202 

,  Average  daily,  Pettenkofer'.s 

and  Voit's,  187 

for  brain- workers,  282 

for  India,  225 

.^—  in  acute  disease,  302 

in  affections  of  the  circulatory 

and  respiratory  organs,  494 
in  albuminuria,  405,  417-420 

in  aniemia,  chlorosis,  neu- 
rasthenia, and  allied  disturb- 
ances of  nutrition,  459 

in  aneurj-sm,  501 

in  apoplexy,  517 

in  aiterio-sclerosis,  497 

in  Arctic  regions,  294 

in  asthma,  506 

■ in  biliary  concretions,  432 

in  Bright's  disease,  417-420 

in  chronic  febrile  states,  478 


Diet  in  convalescence,  319,  320 

in   gout    and   calculous   dis 

orders,  421 

in  phthisis,  491, 

in  senile  heart,  498-500 

in  tropical  countries,  225 

,  sole,  Articles  unsuitable  as, 

205 

,  Subsistence,  of  Playfair,  192 

,    Tables    for   calculation    of, 

195-201 

,  tables.  Von  Noorden's,  393 

under  varying    circumstances 

of  muscular  effort,  192 

Dietaries,  Hospital,  Appendix   I., 
549 

in  neurasthenia,  470-472 

,  Prison,  210-219 

,  Seamen's,  231 

,  Soldier's,  220 

Dietary,  A  mixed,  the  best,  295 

of  young  children,  2C6 

Dietetic  cures,  523 

of  oljesity,  439 

treatment    of    acute    gastric 

catarrh,  329-332 

of  chronic   constipation, 

357 

of  chronic  gastric  catarrh, 

332-337 

^— of  diarrhoea,  359 

of  diseases  of  the  diges- 
tive organs,  326 

Dietetics  of  fever,  305 

of  infancy  and  childhood,  241 

of  neurastlienia,  466 

Diets,  Average  daily,  193 

for  the  dyspeptic,  346 

Difference      in      composition     of 
animal  and  vegetable  foods,  66 

Digestibility  of  different  food-sub- 
stances in  tlie  stomach,  140 

kinds  of  bread,  167,  168 

Digestion,  assimilation,  and  utili- 
sation of  food,  132 

,  Capacity  for,  in  fever,  321 

,  time  required  for,  233 

Digestive  ferments,  535 

organs,  diseases  of.  Food  in, 

326 

Dilatation    of    stomach,    Dietetic 
treatment  of,  343 

of  the  heart,  Diet  in,  498 

Diminution  in  food  required  with 
advancing  years,  284 

Dinner,  Early  or  late,  235 

Disease    caiosed    by   over-feeding. 
277,  278 

,  Food  in,  300 

Diseases  of  digestive  organs.  Food 
in,  326 

to   be   treated    by    the   milk 

cure,  524 

Dispora  caucasica,  57 
Distilled  water,  97 


582 


Food  in  Health  and  Disease. 


Dittmar,  Professor,  analysis  of  tea, 
100 

Diuretic  effects  of  gelatin,  17 

Donkin,  Dr.  Scott,  on  milk  diet  in 
diabetes,  378 

Dried  meat,  167 

— —  vegetables,  177 

Drink,  A  cheap  temperance,  130 

Dry  diet  in  gastric  dilatation,  343, 
844 

-—  for    senile    heart.    Dr. 

Balfour,  499,  500 

cure.  The,  523 

wines,  123 

Drying  foods  for  preservation,  176 

Duck,  39 

Dujardin-Beaumetz,  diet  for  an 
adult  man,  203 

,  his  classification  of  dys- 
peptics and  their  diet,  353 

,  liis  diet  for  gastric  dila- 
tation, 345,  346 

,  his  dietary  in  diabetes, 

899 

on  alcohol  in  acute  dis- 
ease, 317 

-,  on  diet  in  albuminuria, 

41C 

,  on    powdered    meat    in 

phthisis,  490 

,  on  the  effects  of  alcohol, 

109 

,  on  the  functions  of  the 

carbo-hydrates,  22 

,  on  the  utility  of  phos- 
phates, 27 

,  on  wines,  120,  121 

Dukes,  Dr.  Clement,  on  food  at 
school,  26S 

Dilring's  dietary  in  diabetes,  402 

Durrha  or  sorghum,  77 

Dyspepsia,  cardiac,  Food  in,  494-497 

in  infants.  Treatment  of,  356 

,  its  dietetic  treatment,  346 

Dyspeptic,  Diets  for  the,  355 

,  Rule  for  the,  350 

Dyspeptics,  Use  of  tea  and  coffee 
by,  351 

Early  breakfast,  233,  234 

dinner,  234 

Eau  de  vie,  114 

Ebstein's  cure  for  ol)esity,  401 

dietary  in  diabetes,  401 

Eczema  caused  by  food  at  school, 
274 

,  Diet  in,  510 

Edible  fungi,  90 

Eel,  41 

Effects  of  deficient  diet,  203 

of  excessive  diet,  203,  204 

Egg  cordial,  508 

drink,  568 

lemonade,  508 

nog,  568 


Eggs,  Composition  of,  63 

,  Dried,  178 

in  anaemia,  465 

,  Methods  of  preserving,  178 

,  Properties  of,  46,  63,  64 

useful  in  fever,  310 

Embden  groats,  75 

Emulsifying  action   of   pancreatic 

juice,  144 
Endive,  88 
Enemata   of  meat  and   pancreas, 

Leube's,  544 

,  Nutrient,  544 

, ,  in  ulcer  and  cancer  of 

stomach,  338,  341 
Energy    developed    from   different 

food-stuffs,  206-208 
English  system  of  feeding,  234-239 
Entire-wheat  meal  cakes,  170 
Epilepsy,  Diet  in,  519 
Equilibrium  of  metabolism,  11 

disturbed  in  fever,  305 

Erbswurst,  184 
Ergotised  or  spurred  rye,  75 
Escargot,  45 
Ethylic  alcohol,  115 
Examination  of  milk,  52 
of  the   gastric  juice  in  dys- 
pepsia, 353 
Excess  of  albuminates  a  cause  of 

uricsemia,  425 

,  Effects  of,  20 

of  alcohol.  Effects  of,  112 

of  animal   food,    a   cause   of 

cancer  (?),  299 
Excessive  diet.  Effects  of,  203,  204 
Exclusion   of    air    for    preserving 

foods,  179 

Fairchild's   estractum   pancreatis, 

263 

pepsin  in  scales,  539 

zymine,  541 

Farinaceous  foods  in  fever,  315 
Fat,  Absorption  of,  153 

anajmics,  Treatment  of,  472 

,  an  albumen-sparing  food,  18, 20 

,  ComiKjsition  of,  8 

,  Food  that  produces,  290 

formed  from  albuminates,  13, 

14 

for  the  scrofulous,  479 

in  diabetes,  384,  390 

,   Influence    of    on    muscular 

exercise,  20 
Fats  and  carbo-hydrates,   Relative 

value  in  diets,  205,  206 

,  Digestion  of,  141,  145,  146 

in  anaemia,  465 

in  scrofula,  479 

in  the  diet  of  the  gouty,  426 

or  hydro-carbons.  Class  of,  8 

Feeding  habits  of  the  carnivorous 

and  herbivorous  animals,  232 
of  the  insane,  512 


Index. 


583 


Ferments  in  gastric  juice,  135, 130 

Fever,  Dietetics  of,  305 

,  Feeding  in,  321-325 

,  Importance  of  water  in,  314, 

316 

,  Jellies  in,  308,  315 

,  Need  of  albuminates  in,  305, 

306 

,  Purpose  of  nitrogenous  food 

in,  314 

,  Raw  meat  in,  315,  320 

Fevers,  Necessity  for  maintaining 
intestinal  antisepsis  in,  321 

,  Tea  and  coffee  in,  316 

Fibrin,  7 

,  Vegetable,  67 

Filters,  98 

Figs,  92,  94 

Fining  of  wines,  119 

Fish,    circuinstances     which     In- 
fluence its  food  value,  41,  42 

,  Cooking  of,  164 

diet    favourable     to     brairi- 

development,  42 

,  Edible   properties    and   com- 
position of,  40 

,  Modes  of  preserving,  181 

Five  o'clock  tea,  235 

Flesh    of   different   animals,  their 
food  properties,  34 

Flint,  Dr.,  on  whisky  in  phthisis, 
488 

Flounder,  41 

Flour  of  wheat,  71 

Fluid   foods    necessary   in    fever, 
308 

Food  accessories,  9 

of  animal  organisms,  3,  5 

,  Assimilation  of,  132 

at  school,  268,  276 

,  Classification  of,  6-9 

,  Concentration  of,  230 

,  Cooking,     preparation,     and 

preservation  of,  175-184 

,  Definition  of,  2 

,  Digestion  of,  132 

for  the  expectant  mother,  245 

habits  of  animals,  232 

of  different  races,  294 

in  adult  life,  276 

in  advanced  age,  284 

In  albuminuria,  405 

in  diabetes,  363 

in  disease,  300 

in  fever,  821-325 

in  health,  1 

in  infancy  and  childhood,  241 

in  relation    to  age   and  con- 
dition, 241 

in    rickets,    scurvy,    scrofula, 

consumption,  and  chronic  febrile 
conditions,  forced  feeding  (sur- 
alimentation),  474-493 

,  Non-organic,  9 

of  vegetable  organisms,  3,  5 


Food,  Organic,  9 

,  Origin  of,  3 

,  Purpose  of,  1,  2 

stuffs,  31 

,  Utilisation  of,  148 

Foods  predigested,  535,  539 

suitable  to  advanced  life,  284 

Force- value  of  various  foods,  206 

Forced  feeding,  489 

Fortified  wines,  119,  123 

Fowl,  39 

Fox,   Dr.    Wilson,    on    alcohol    in 

pneumonia,  604 
Frankland's  artificial  human  milk, 
255 

-  table  of  potential  energies  of 
food-stuffs,  207 

French  soldier's  rations,  226 
Frozen  meat.  Loss  in  cooking,  179 
Fmit  soups  in  fevers,  316 
Fruits,  Dried,  178 

, ,  Properties  of,  92 

,    Fresh,    their    antiscorbutic 

properties,  92 

, ,  Composition  of,  91,  92 

, ,  Properties  of,  93 

Frying,  163 

Functions  of  mineral   substances 

in  food,  25 

of  the  albuminates,  13, 15 

of  the  carbohydrates,  20 

of  the  hydro-carbons,  17 

of  water,  25 

Fungi,  Edible,  90 

Fusel  oil  (amylic  alcohol),  115 

Fuster,    Prof.,   on   raw    meat    in 

phthisis,  486 

Galactophore,  The,  563 
Galazyme,  Composition  of,  58 

in  phthisis,  485 

Gall-stones,  Diet  in,  433 
Game  as  food,  S.l 

for  invalids,  39 

Gastric  catanh  caused  by  excess  of 
food,  328 

caused    by    unsuitable 

food,  328 

,  Suitable  foods  for,  330- 

337 
digestion,  135, 136 

,    Circumstances    which 

retard,  142 

juice.  Composition  of,  135,  136 

,  Examination  of  in  dys- 
pepsia, 353 

,  Ferments  in,  135, 136 

Gelatigenous  substances,  16 
-teelatin,  7 

,  an  albumen-sparing  food,  17 

,  a  peptogenic  food,  17 

,  Diuretic  effects  of,  17 

,  Value  of,  in  fevers,  312 

German  beers,  Konig's  analysis  o( 
127 


S84 


Food  in  Health  and  Disease. 


German  soldier's  rations,  228 

system  of  feeding,  237 

Gherkins,  88 

Gin,  115 

Girls'  schools.  Defective  feeding  in, 
274 

Glacialin,  181 

Gliadin,  67,  71 

Globulin,  7,  147 

Gluten,  71 

bread,  381 

——  casein,  73 

^—  fibrin,  73 

or  vegetable  fibrin,  7,  67 

Glycerin,  20 

Glycerine  in  rectal  aUnientation, 
545 

Glycogen  formed  from  albumin- 
ates, 15 

Glycogenic  function  of  liver,  147, 
368 

Glycosuria  and  uric  acid,  371-370 

,  Food  in,  369 

,  its  causation,  365 

,  Metabolism  of  carbohydrates 

in,  376,  380 

— ^,  Von  Noorden's  classification, 
389 

,  Von  Noorden's  diets,  388-395 

Goat's  milk,  246 

— — ,  Composition  of,  49 

Goldsmitli,  Surgeon-Miijor,  method 
of  rendering  milk  digestible,  335 

Goose,  39,  40 

Gooseberries,  93 

Gout,  Alcoholic  beverages  in,  431 

,  Alkaline  waters  in,  430 

—  and  rheumatism  from  over- 
feeding, 278,  284 

,  Cantani's  diet  for,  437 

,  Cider  in,  431 

•^— ,  Cocoa  in,  432 

,  Diet  in,  421 

,  Milk  in,  429,  430 

,  Tea  and  coffee  in,  432 

— ,  Wines  in,  431 

Gouty  contracted  kidney,  Milk 
diet  in,  414 

diabetics,  371 

Grain  of  wheat,  Structure  of,  72 

Granulose,  133 

Grape,  91,  95 

cure,  632 

,  Prof.  Lebert  on,  532 

sugar,  68,  95 

Grapes,  Composition  of,  533 

Grave,  Vin  de,  121,  123 

Green  artichoke,  87 

fruits  for  diabetics,  668 

tea,  99 

-—  vegetables,  Ksnig's  analysis  of, 
89 

,  Mode  of  cooking,  174 

,  their  composition,  86,  86 

Grilling,  162 


Groats,  Embden,  75 

Grog  de  lapoudre  de  viande,  400 

Grouse,  39 

Gruel,  Oatmeal,  75,  213 

, or  barley,  in  fever,  316 

,  Peptonised  milk,  542 

Gubler,  Professor,  on  vegetarianism, 

294 
Guineafowl,  39 
Gum,  8 
water,  668 

Habitual  diets  of  persons  of  dif- 
ferent occujiations,  190 

Haddock,  41 

"  Hanging  "  meat,  Reason  for,  S3 

Hard  labour  piison  diets,  219 

Hare  as  food,  39,  40 

Haricot  beans,  their  food  value,  297 

Haricots  llancs,  79 

Hassall's  flour  of  meat,  177 

Heart,  affections  of  tl»e.  Diet  in, 
494-502 

,  Dr.  Balfour's   diet  in, 

498-502 

as  food,  38 

"  Hea\'y  teas,"  Objection  to,  236 

Helix  pomatia,  45 

Hemi-albumose,  136 

Hemiplegia,  Diet  in,  517 

Herring,  41 

Hircin  or  hircic  acid,  50 

Hock,  Sparkling,  12' 

Hoe-cakes,  76 

Hollands,  115 

Hominy,  70 

Honey,  95 

Hospital  dietaries.  Appendix  I.,  549 

Hot  tea  in  obesity,  419 

water  after  meals,  239 

as  a  drink  for  tlie  gouty, 

430,  434,  437 

before  food   in   gastric 

disorders,  844 

in  dUatation  of  stomach, 

346 

in  dyspepsia,  351 

in  obesity,  452,  454 

Huchard's  diet  for  gastric  dilata- 
tion, 345 

Human,  cow's  and  ass's  milk  com- 
pared, 248 

body,  its  composition,  5 

milk,  Aitificial,  255 

,  Composition  of,  49,  248 

,  Variability  in  composi- 
tion of,  247 

Hungarian  wines,  123 

Hydrocarbons,  Composition  of,  8 

,  their  functions  in  nutrition,  17 

,  their  relations  to  the  temper- 
ature of  the  body,  18 

Hydrochloric  acid  in  gastric  jnice^ 
135 

Hydrometer,  53 


Index. 


58s 


Iced  water,  98 

Iceland  moss  bread  for  diabetic?, 

375 

,  Bread  made  of,  91 

Idiosyncrasies     witli     regard     to 

articles  of  diet,  2S3 
Imperfect  mastication  a  cause  of 

gastric  catarrh,  329 
Imperial  drinks,  568 
Importance  of  nitrogen,  4 
Income  and  output,  Bodily,  187 
Indian  corn,  76 

dietary,  225 

Indigestion,    Causes    and  dietetic 

treatment  of,  346 
Individual  reactions  to  alcohol,  111 
Indol,  144 
Infancy  and  childhood,  Food  in, 

241 
Infant,  Rate  of  growth  of,  252 
Infants,  Ansemia  in,  465 

,  Cause  of  diarrlioea  in,  861 

,  :Meat  broth  for,  203 

,  Treatment  of  dyspepsia  in,  356 

Infant's  stomach.  Capacity  of,  252 

foods,  251,  252,  263 

Influence  of  diet  on  the  milk  secre- 
tion, 245 
Injurious  effects  of  tea,  102 
Insalivation,  132 
Insane,  Feeding  of  the,  512 
Insomnia,  Diet  in,  518 
Insufficiency  of  convict  prison  diets 

for  soldiers,  219,  220 
Intervals  between  meals,  232 
Intestinal  antisepsis,  Necessity  for, 

in  fever,  321 
Inulin,  68 

biscuits  for  diabetes,  374 

Invalids'    dietary.    Select   recipes, 

Appendix  III.,  564 
Iron,  its  distribution  in  the  body, 

26 

Jaccoud,  Prof.,  on  milk  in  phthisis, 

483 
Jellies  in  fever,  315 
Jenner,  Sir  W.,  on  vegetable  soups 

in  fever,  314 
Jerusalem  artichoke,  83 
Joliannisberg,  121,  122 
Johnson,  Sir  George,  on  milk  diet 

in  Bright's  disease,  417 
Julienne  soup  iu  fever,  314 
Junket,  568 

Karell  on  the  milk  cure,  524 
Kefir  for  feeding  infants,  267 
Kerr,  J.  L.,  on  boiled  milk,  558 
Kidney,  gouty.  Milk  diet  in,  414 
Kidneys  as  food,  38 
Kirsch  or  kirsch-wasser,  115 
Kola,  109 

Konig's  Tables  of  Analysis,  36,  44, 
49,  59,  S9,  90,  104,  108,  117, 127 


Koumiss,  50,  56,  579 

,  Composition  of,  531 

cure,  The,  529 

,  Home-made,  509 

in  chronic  diarrhoea,  362 

in  phthisis,  484 

Kiimniel,  116 

Latour  on  goat's  milk  in  phthisis, 
484 

Lactic  .acid,  47 

ferment  in  gastric  juice, 

136 

,  its  formation  from  carbo- 
hydrates, 24 

Lactometer,  53 

Lactose,  Properties  of,  47 

a  diuretic,  528 

Lait  (lepoiile,  65,  569 

La  Langouste,  44 

Larj-ngeal  catarrh,  Wbey  cure  in, 
628 

Late  dinner,  235 

Lavage  d'estomac  in  'gastric  dilata- 
tion, 343 

Lawes'  and  Gilbert's  experiments, 
15, 

Leavened  bread,  165 

Lebert,  Prof.,  on  the  grape  cure, 
532 

Lecithin  in  yolk  of  egg,  65 

L'Ecrevisse,  44 

Lees  of  wine,  119 

Legumin,  7,  78 

or  vegetable  casein,  67 

Leguminosie  or  pulses,  78  < 

Lemon,  lime,  and  shaddock  as 
antiscorbutics,  93 

peel  tea,  569 

wliey,  310 

Lemonade,  569 

in  fever,  317 

Lentils,  80 

Leoville,  121 

Lettuce,  87 

,  Stewed,  for  diabetics,  569 

Leube's  diets  for  the  dyspeptic,  355 

enemata  of  meat  and  pancreas, 

545 

meat  solution,  543 

soluble  meat  in  gastric  ulcer, 

339 

Lichenin,  68 

Liebig's  extract,  183 

food,  243,  251 

infants'  food,  243,  251,  537 

theories,  12,  17 

Light  puddings,  174 

Lime,  The,  93 

water,  how  to  prepare,  256 

Limitation  of  beverages  in  obesity, 
449 

Linseed  in  constipation,  859 

tea,  570 

Liqueur  or  spiritoous  wines,  122 


586 


Food  in  Health  and  Disease. 


Liqueurs,  116 

Liver,  its   composition  and  food- 
value,  38 
Lobster,  Composition  of,  43 
Locomotor  ataxia.  Diet  in,  518 
Loeflund's  infant's  food,  251 

peptonised  kinder-milch,  541 

Longevity  and  spare  diet,  285 
Loomis  on  beef-juice  in  plithisis, 

486 
Loss  of  weight  in  boiling,  158 

— — in  roasting,  160 

in  stewing,  161 

Lunatics,  Forced  feeding  of,  612, 

516 
Luncheon,  234 
Lupulin,  129 

McCall's  process  for  preserving 
foods,  179 

Macaroni,  73,  173 

,  a  ritalienne,  174,  570 

,  vermicelli,  etc.,  73,  173 

Mackerel,  41 

MaQon,  121 

Madeira,  121 

Maglieri's  recipe  for  lemonade,  317 

Maize,  Composition  and  pro- 
perties of,  70,  75,  76, 

Maizena  or  com  tlour,  76 

Malaga,  121,  123 

Malic  acid  in  fmits,  93 

In  wine,  118 

Malt  and  rice  pudding,  570 

extract  in  gastric  ulcer,  339 

,  Sterilised    hopped.    In 

typhoid,  324 

extracts,  530 

in  phthisis,  487 

Malted  foods,  337 

Malting,  126 

Maltose,  132 

Mannite,  6S 

Maraschino,  116 

Mare's  milk,  Composition  of,  49, 
50,  57,  531 

Marsala,  121 

Marrow,  Vegetable,  88 

Marschberg,  122 

Masson  and  Challofs  preserved 
vegetables  177 

Mastication,  132 

,  Imperfect,  as  a  cause  of  dys- 
pepsia, 347 

Mat6  or  Paraguay  tea,  108 

Meal-times  of  children,  237 

Meals,  Hours  of,  233-239 

,  Intervals  between,  232 

Meat  biscuits,  184 

extract,  183 

,  HassaU's  flour  of,  177 

infusions    and    extracts    in 

fevers,  311 

juice  in  typhoid,  323.    (Se«  olw 

Raw) 


Meat,  lean,  Peptonised,  543 
——  peptones,  540,  541 

ration    of    several   European 

armies,  230 

solution,  Leube's,  543 

tea,  570 

Medicated  milk,  51 

Meigs'  cream  mixture  for  infants,  262 

on    condensed    and    human 

milk,  249,  250 

Melitose,  68 

Mellin's  food,  243,  256,  258,  538 

Melon,  94 

Meningitis,  acute.  Diet  in,  517 

Metabolism,  10 

of  albuminous  substances   of 

body  increased  in  febrile  dis- 
eases, 305 

Milk  a  complete  food,  0 

and  suet,  570 

as  a  food  in  febrile  diseases, 

309 

as  food  for  adults.  Defects  of, 

46 

,  ass's.  Composition  of,  49,  50 

,  Changes  in,  induced  by  boil- 
ing, 558 

,  Coagulation  of,  52,  256 

,  Composition  of,  6,  46 

,  Condensed,  64 

curdling   ferment    in    gastric 

juice,  136,  138 

cure,  The,  524 

,  Desiccated,  182,  465 

diet  in  affections  of  the  cir- 
culatory organs,  495-40S 

in  albuminuria,  417 

— —  in  Bright's  Disease,  411 

——  in    cancer    of    stomach, 

341 

in  chronic  diarrhoea,  359 

— gastric  catarrh  and 

gastric  ulcer,  330,  334,  338 

in  consumption,  482 

in  neurasthenia,  468 

,  Dried,  182 

,  Examination  of,  52 

,  goat's.  Composition  of,  49 

gruel,  Peptonised,  542 

,  human.    Composition  of,   50, 

61,  248  250 

in  diabetes,  373,  378 

,  Infected,  cause  of  diarrhoea  in 

infants,  361 

in  fever,  321 

in  old  age,  48 

lemonade,  569 

,  mare's.  Composition  of,  49 

,  Medicated,  51 

,  method  of  rendering  it  digest- 
ible, 335 

,  Microbes  in,  557 

,  objections  to  its  use  in  fever, 

809 

of  wet-nurse,  51 


Index. 


587 


Milk,  Peptonised,  541,  542 

,  Precautions  in  its  use  in  fever, 

309 

,  Preservation  of,  54,  181,  182 

,  Rice,  574 

,  Salts  of,  47 

— ,  sheep's,  Composition  of,  49 

•,  Skiiumed,  54 

,  ,  in  ansemia  in    infants, 

463 

soup,  570 

,  Sour,  .in  cancer  of  stomach, 

342 

,  Souring  of,  47 

,  Sterilisation  and  Pasteurisa- 
tion of,  Appendix  II.,  557-563 

,  Variations  in  composition  of, 

49 

Millet,  Composition  of,  77 

Minced  Beef,  458 

Mineral  foods  and  water,  Class  of, 
8,9 

substances,  Functions  of,  25 

waters.  Class  of,  8,  9 

Mixed  diet,  Importance  of,  29,  295 

Mode  of  making  tea,  101 

Modern  "  vegetarians,"  292 

Molasses,  95 

Moleschott's  estimate  of  daily  food 
requirements,  190 

standard  diet,  199 

MoUusca,  43-45 

Money,  Dr.  Angel,  on  infant  feed- 
ing, 258 

Monotony  of  diet  injurious,  149 

Morelle,  90 

Moselle  wines,  118,  121 

Mother,  Food  of  expectant,  245 

Mucediu,  71 

Mulberry,  94 

Muscle,  Composition  of,  32 

Mushroom,  90 

Mussel,  Properties  of,  45 

Must,  Composition  of,  117 

Mustard  and  cress,  88 

Mutton  broth,  571 

and  chicken  broth,  571 

,  Properties    and    composition 

of,  36 

Myosin,  33 

BIytilotoxin,  45 

Nectarines,  93 

Kiel,  Dr.,  on  feeding  the  insane, 
512-516 

Nephritis,  chronic  parenchy- 
matous. Milk  diet  in,  414 

Nervous  system,  Feeding  in  dis- 
eases of,  517 

Nestle's  food,  243,  538 

Neurasthenia,  Diet,  etc.,  in,  466 

,  Massage,  etc,  in,  468 

Neurasthenic  Dietaries,  470 

Nitrogen,  Importance  of,  in  nutri- 
tion, 4 


Nitrogen,  Quantities  of  food  required 

to  supply  the  necessary,  205 
Nitrogenous  alimentarAr  principles, 

6^9    -  J. 
foods  promote  axidation,  290, 

291 

substances,  Functions  of,  13 

Non-nitrogenous  foods,  9 

organic  food,  9 

Noorden,    Von,    diet    in    diabetes, 

376,  388-395 
on  formation  of  sugar  in 

diabetes,  364,  376,  380 
Notter,   Surgeon-Major,    M.D.,    on 

soldiers'  rations,  223,  224 
Noyean,  116 

Nursing  mother's  diet,  242 
Nutrient  enemata,  338,  341,  545 
Nutritive   value   and   uses  of   the 

different  classes  of  food,  12 

Oatmeal,  Composition  and  pro- 
perties of,  74,  75 

for  the  tuberculous,  487 

gruel,  571 

porridge,  571 

^—  soup,  572 

water,  262 

Oats,  Composition  and  properties 
of,  70,  74,  75 

Obesity,  455 

,  causes  of,  439 

,  Cures  for,  442 

, ,  Banting's,  443 

, ,  Dancel's,  442 

, ,  dry,  442 

, ,  Ebstein's,  443 

, ,  Oertel'^,  445 

, ,  Salisbury's,  451,  455 

, ,  Schweninger's,  445 

,  Dietetic  treatment  of,  439 

,  Hot  tea  in,  449 

;  Limitation   of  beverages   In, 

449 

,  Methods  of  treating,  439,  442 

,  Skimmed  milk  in,  450 

Oertel's  cure  for  obesity,  445 

Ofner,  123 

Onions,  88 

Oppolzer  on  sour  milk  in  cancer  of 
the  stomach,  842 

Oranges,  91,  93 

Order  and  frequency  of  taking  food, 
232 

of  courses  at  dinner,  237 

Ordinary  articles  of  food  and  drink, 
31 

Orenberg,  Koumiss  cure  at,  629 

Organic  albumen,  14 

food,  9 

Orgeat,  672 

Origin  of  food,  3 

Osteo-arthritis,  Diet  in,  510 

Over-feeding  in  adult  life,  277 

a  cause  of  disease,  278 


588 


Food  in  Health  and  Disease. 


Oxford  and  Cambridge  method  of 

training,  2S1 
Oyster  broth,  572 
Oysters,  Properties  of,  44 

Pancreatic  digestion,  144, 145 

emulsion  in  phtliisis,  4S5 

extract  (Fairchild's),  203 

extracts,  539 

juice,  143 

Pancreatin,  540 

Pancreatised  cod-liver  oil  enemata, 

409 

foods,  541 

Papain,  143 

Pa  a-peptone,  136 

Faikes  on  alcohol,  112 

on  eoft'ee  as  a  stimulant,  105 

on  nitrogen,  4 

on  soldiers'  diets,  227,  228 

Parsnip,  85 
Partridge,  39,  40 
Pasteurisation  of  milk,  558 
Pastry,  Indigestibility  of,  173 
Pate  d'ltalie,  73,  173 
Pavy  on  alcohol,  110 

,  beef-tea,  565 

on    fonnation   of    sngar   la 

diabetes,  868 

on  glycosuria,  366,  368 

Pavy's  dietary  in  diabetes,  397 

Peaches,  93 

Pear,  91,  93 

Pearl  barley,  74 

Pea  sausage  or  Erbswurst,  184 

Peas,  SO 

,  Digestibility  of,  152 

,  Mode  of  cooking,  174 

Pectin,  or  vegetable  jelly,  9,  68,  93 
Pemmican,  176 
Pepsin,  135,  538 

in  ansemia,  464 

,  Variability  of,  539 

"  Peptogenic    Milk    Powder "    of 

Fairchild,  260 
Peptones,  136-138,  540 

,  their  toxic  action,  140 

,  Value  of,  140 

Peptonised  beef-tea,  543 

cocoa  and  milk  in  phthisis,  485 

enemata,  672 

foods,  640 

lean  meat,  643 

milk  in  ansemia,  464 

milk-gruel,  542 

in  phthisis,  482 

suppositories,  646 

Peptonising  milk,  260,  642 

Perry,  125 

Pettenkofer's  andVoit's  experiments 

on  food  requirements,  186 
Pheasant,  39 

Phosphates,  Utility  of,  26,  27 
Phthisis,  Daily  dietary  in,  491 
,  Food  in,  480 


Phthisis,  Milk  in,  482 

,  Raw  meat  in,  485,  486 

,  Suralimentation  in,  489 

"  Physiological  albuminuria,"  406 

equilibrium,  11 

Pi:;eon,  39 

Pilchard,  41 

Plaice,  41 

Plantain,  94 

Plastering  of  wines,  120, 123 

Plastic  or  tissue-forming  foods,  13 

Play  fair's  subsistence  diet,  192 

Pleurisy,  Diet  in,  505 

Plums,  93 

Pneumonia,  acute.  Diet  in,  503 

Polenta,  70 

Pollards  or  bran-flour,  71 

Pork,  Properties  and  composition 

of,  37 
Porridge,  Oatmeal,  75,  214,  571 
Port,  121,  122,  124 

wine  jelly,  572 

Porter,  120,  128,  129 

Potassium  and  sodium  phosphates, 

26 
salts,  their  distribution 

in  the  body,  26 

sulphates,  26 

chloride  in  blood-cells  and  in 

muscle,  26 
Potato  gruel,  476 

,  Properties  of,  81 

,  The  sweet,  82 

Potatoes    as   an   antiscorbutic   In 

prison  diet,  213 

,  Mode  of  cooking,  174 

,  Preservatioii  of,  177,  183 

Potential  energies  of  food-stutfs,  207 
Poultry  and  game,  39 

,  Composition  of,  40 

Powdered  meat,  177,  572 
Powders,  Banger's  peptonising,  541 
Prawns,  44 

Predigested  foods,  535,  539 
Preparation  of  food    (See  Cooking) 
Preservation  of  foods,  175 

of  milk,  64 

Preserved  vegetables,  177 
Prison  diet,  Defects  in,  219 

dietaries,  210-219 

Professional    and    upper    classes, 

system  of  feeding,  237 
Prognosis  in  diabetes,  369 
Proof  spirit,  113 
Pro-peptone,  136 
Propylic  alcohol,  115 
Proteids,  7 
Protein,  7 

"  Provincial  system"  of  feeding,  236 
Prunes  to  remedy  constipation,  93 
Ptomaines,  138 
Ptyalin,  132,  133 
Pudding,   Almond,  for  diabetics, 

664 
,  Rice,  674 


Index. 


589 


Paddings,  irs,  174 

Pulmonary  consumption,  Diet  in, 

480    (:>'ee  also  Plilliisis) 
Pulp  of  raw  meat,  or  pounded  raw 

meat,  in  fevers,  316,  320 
Pulses,  The,  78 

,  Composition  of,  79 

Purpose  of  food,  1,  2 

Putrefactive  bacteria  in  alimentary 

canal,  141 

Quail,  39 

Quantity  of   food   conditional    on 
physical  activity,  279 

Rabbit,  40 

Rabuteau   on  sodium  chloride  in 

food,  27 
Radish,  85 
Pain  water,  97 
Raisin,  92 

Range  of  various  diets,  202 
Raspberries,  93 
Raw  and  cooked  fruits,  93 

eggs  in  Bright's  Disease,  410 

meat,  572 

in  an;ieniia,  464 

in  chronic  diarrhoea,  SCO 

in  fevers,  315,  320 

in  phthisis,  485,  480 

juice,  400,  475,  572 

for  infants,  203,  331 

pulp,  400 

in  rickets,  475 

soup  (of  beef),  408 

Ray,  42 

Recipe  for  making  soup  in  prisons, 

213 
formaking  stirabout  in  prisons, 

214 

for  meat  biscuits,  184 

. for  suet  pudding  in  prisons, 

213 
■Recipes,  Select,  Ste  Appendix  III., 

504 
Rectal  alimentation,  544 
Rectum,  Absorption  in,  544 
Red  or  astringent  wines,  117,  123 
•Regular  meal-times.  Necessity  for, 

232 
Relative  advantages  of  animal  and 

vegetable  foods,  2S9 
suitability  of  ditferent  articles 

of  diet,  205 
value  of  foods  of  the  same 

class,  29 
Remissions  in  febrile  disease  favonr- 

alJe  for  administration  of  food, 

307 
Rennet,  47 
•Reportof  Parliamentary  Committee 

otj  Soldiers'  Dietary,  222 
Respiratory  organs.  Diet  in  diseases 

of  tlie,  602 
or  beat-fori»ing  foods,  13 


Rest  before  and  after  food,  238,  239 

in  anaemia.  Importance  of,  463 

Retarders  of  gastric  digestion,  142, 

143 

of  salivary  digestion,  133 

Revalenta,  SO 
Revalesciere,  80 
Rheumatism,  Diet  in,  508,  501 
Rheumatoid  arthritis,  Diet  in,  510 
Rice,  Composition  and  properties 

of,  70,  70 

,  Mode  of  cooking,  174 

,  Preparations  of,  recipes,  574 

,  Properties  of,  77 

Rickets,  Food  in,  474 
Rigor  mortis,  its  cause,  33 
Roasting,  Etfects  of,  159 
Roberts,  Sir  W.,  dietary  in  diabetes, 

398 

,  experiments  with  coffee,  106 

on  milk  in  diabetes,  379 

on  tea,  100-102 

on  tlie  influence  of  alcohol  on 

digestion,  113,  116,  134 

of  beer  on  digestion,  129 

of  wines  on  digestion,  125 

Robin    on    diet    in    convalescenco 

from  typhoid,  320 
Roe,  Hard  and  soft,  of  fish,  42 
Roots  and  tubers,  81 

,  Konig's  analysis  of,  89 

Rubner  on  digestibility  of  different 

foods,  151 
Rudesheimer,  121,  122 
Rules  for  feeding  in  fever,  308 

for  infant- feeding,  254 

for  the  dyspeptic,  350 

Rum,  114 

Ruster,  121 

Rye,  Composition  and  properties 

of,  70,  75 

Saccharin  for  dial)etics,  386 

substances,  8,  94 

wines,  123 

Sago,  84,  574 

St.  Julien,  121 

Salad  vegetables,  88 

Salads,  175 

Salep,  84 

Salicylic  acid  for  preserving  food, 

181 
Salisbury  cure  for  oliesity,  451,  455 
Saliva,  Functions  of,  132 
Salmon,  41,  42 
Salsify,  85 
Salt  as  a  condiment,  130 

for  clilorotics,  466 

Salted  meats,  Objections  to,  ISO 

Salting  foods,  180 

Salts  of  milk,  47 

of  the  vegetable  acfds,  their 

importance,  27 
Sauer-kraut,  87 
Sautemes,  123 


590. 


Food  in  Health  and  Disease. 


Savory  and  Moore's  food,  243,  538 

peptonised  milk,  262,  482 

^—  cocoa  and  milk  in 

phthisis,  485 
Schedule  of  infant  feeding,  257 
Schweninger's  cure  for  obesity,  445 
School,  Food  at,  268-276 
Schrott's  dry  diet,  508 
Scientific   basis   of   dietaries   and 

rations,  185 
Scotch  ale,  128 

or  pot-barley,  73 

Scrofula,  477 

,  Diet  in,  477 

Scurvy,  Diet  in,  476 

,  relation  to  vegetable  salts,  27 

Seakale,  87 

See,     Germain,    diet    for    gastric 

dilatation,  345 

, ,  dietary  in  diabetes,  398 

, ,  on  alcohol  in  phthisis, 

488 

, ,  on  beef-tea,  311 

, ,  on  milk  in  phthisis,  483 

, ,  on  tea  as  a  beverage,  852 

, ,  on  the  functions  of  the 

carbohydrates,  22 

, ,  soldiers'  diets,  227 

Seegen's  almond  cakes  for  diabetics, 

383 

dietary  in  diabetes,  397 

Select  recipes,  Appendix  III.,  564 
Semmola's  beverage  for    cases    of 

albuminuria,  417 
Semolina  (Fr.,  Simmlt),  73 
Shaddock,  The,  93 
Sheep's  milk,  Composition  of,  49,  50 
Sherry,  121, 122 
Shrimps,  44 
Skimmed  milk  as  a  cure  for  obesity, 

450 

— ,  Composition  of,  54 

in  anaemia,  463 

in  diabetes,  378 

Skin  diseases  caused  by  errors  of 

diet,  510,  511 

,  Diet  in,  610 

Sleep,  Food  and,  238 
Smith,  Professor,  diet  in  albumin- 
uria, 418 
Smoked  bacon.  Digestibility  of,  181 
Smoking  foods,  180 
Snail  (escargot),  45 
Snipe,  39 
Soda,  Bicarbonate  of,  to  neutralise 

acidity  of  cooked  fruits,  287 
Sodium  carbonate  and  bicarbonate 

in  the  blood,  26 

—  chloride  in  chlorosis,  466 
in  food,  27 

—  ,  its  importance   in  the 

body,  25,  26 

Soldiers'  dietary,  220 

,  Report  of  Parliamentary 

Coa:iaitt*e  on,  222 


Soldiers'  rations,  Austrian,  229 

,  French,  226 

,  German,  228 

,  Russian,  230 

,  Professor  J.  L.  Notter, 

M.D.,  on,  230 
Sole,  41 

Solids  in  cow's  milk,  47 
Sorghum  or  durrha,  77 
Sorrel,  87 
Soup  at  commencement  of  dinner, 

its  value,  237 
in  prisons,  Recipe  for  making, 

213 

,  Rice,  574 

Soups,  Fruit,  in  fevers,  316 

Souring  of  milk,  47 

Soxhlet's    method    of    sterilising 

milk,  561 
Soya  bean-flour,  Analysis  of,  384 

bread  for  diabetics,  383 

Sparkling   wines.   Preparation    of, 

120 
Spinach,  87 
Spirits,  Ardent,  113 
Sprat,  41 
Spring  water,  98 

Ssaraara,  Koumiss  cure  at,  484,  52d 
Standard  daily  diets  for  a  man  in 

ordinary  work,  202 
Stange,  Dr.,  on  the  koumiss  cure, 

531 
Starch  granules.  Action  of  heat  on, 

in  cooking,  164 
Starchy  substances,  8 
Starr,   Dr.    Louis,   on  dietetics  of 

infancy  and  childhood,  243 
, ,  rules  for  infant  feeding, 

254,  257 
Steapsin,  144 
Steiii-Reisling,  122 
Sterilisation  of  milk,  557-563 
Sterilised  hopped  malt  extract  in 

typhoid,  324 
Stewart,  Prof.  Grainger,  on  albu- 
minuria, 406,  408 
Stewing,  160 
Stimulants,  9 

and  condiments,  their  uses,  29 

in  dyspepsia,  351 

Stii-about    in    prisons.  Recipe   for 

making,  214 
Stoekvis  on  albuminuria,  407 
Stomach,  cancer  of.  Food  in,  340 

,  Dilatation  of.  Food  in.  343 

,  diseases  of,  Food  in,  320 

,  nicer  of.  Food  in,  337 

Stowell,   Dr.,  on    cow's   milk    for 

infants,  256 
Strawberry,  91,  92,  94 
Subcutaneous  injection  of  food,  547 
Subsistence  diet  of  Playfair,  192 
Substitutes  for  milk  in  infant  feed- 
ing, 201 
for  mothers'  milk,  244,  244 


Index. 


591 


Succus  camis,  575 

Succris  entericus,  Functions  of,  146, 

147 
Buet  piiddings  in  prisons,  Recipe 

for,  213 
Sugar,  94 
formed     from     nitrogenous 

matters,  863,  367 

in  diabetes,  Formation  of,  364 

in  the  blood,  364 

in  the  urine,  363 

Supper,  237 

Suppositories,  Peptonised,  546 

Suralimentation  in  phthisis,  489 

Sweetbread,  38 

Sweet  potato,  82 

wort,  127 

Swiss  milk  and  whey  cm-es,  483 
Syntonin,  7 

or  acid-albumen,  186 

System  of  feeding  of  the   upper 

classes,  237 
Systems  for  curing  obesity,  442 

Tables  for  calculation  of  diets,  195- 
201 

Tannic  acid  in  tea,  99,  100 

Tannin  in  wine,  118,  122 

Tapioca,  84 

jelly,  575 

soup,  575 

Tartaric  acid  in  fruits,  92,  9b 

in  wine,  122 

Tasajos  (dried  meat),  176 

Tea  and  coffee  for  the  gouty,  432 

in  cardiac  dyspepsia,  495 

in  dyspepsia,  351,  352 

in  fevers,  316 

,  Composition  of,  99,  100 

,  Differences  between   Indian 

and  China,  100 

— ^,  Inhibitory  effects  on  diges- 
tion, 103, 

,  its  injurious  effects,  102 

-^— ,  its  stimulating  and  restora- 
tive effects,  101 

,  Mode  of  making,  101 

or  coffee  after  dinner,  Objec- 
tions to,  239 

Temperance  drink,  A  cheap,  130 

Temperature,  Influence  of  on  diet, 
282 

Tendency  to  excessive  consump- 
tion of  animal  food,  295 

Thein,  98 

Theobroma  cacao,  106 

Theobromin,  98,  106 

Thompson,  Sir  H.,  on  braising, 
161 

on  diet  in  calculous  disorders, 

434 

on   excessive  use   of  animal 

food,  297,  298 

on  frying,  163 

on  macaroni,  173 


Tliompson,  Sir  H.,  on  the  haricot 

bean  and  its  food- value,  296 
on  the  times  of  taking  meals, 

235 
— -  on   the  use  of  entire-wheat 

meal,  170 
,  recipe  for  making  whole-meal 

cakes,  170 
Time  required  for  digestion,  350 
Tissue-forming  foods,  13 
Toasting,  171 
Toast  water,  575 
Tokay,  119, 121 
Tomato,  88 

Tongue,  its  food-value,  38 
ToiTifled  bread  for  diabetics,  382 
Tons  les  mois,  84 
Toxic  action  of  peptones,  140 

effects  of  alcohol,  111,  112 

of  coffee,  105 

Training  at  Oxford  and  Cambridge, 

281 

,  Food  in,  279,  2SC 

Treacle,  95 

posset,  575 

Trimethylamin,  40 
Tripe  as  food,  88 

Tropical  countries.  Diet   for   Eu- 
ropeans in,  225 
True  diabetes,  370 
Truffle,  90 
Trypsin,  143,  540 
Ti-yptone,  144 
Tscherwinsky  on  the  conversion  of 

carbohydrates  into  fat,  23 
Tubercle  bacillus,  Influence  of  food 

on,  481 
Tuffuell's  diet  in  aneurysm,  502 
Turbot,  41 
Turnip,  85 
Typhoid  fever.  Failure  of  milk  in, 

821 
,  Sterilised  hopped  malt 

extract  in,  824 

Ulcer  of  stomach.  Dietetic  treat- 
ment of,  337 

Unfermented  cakes,  172 

Urea,  Elimination  of,  13 

,   Excessive   excretion   of,    in 

anaemia,  462 

,  Excretion  of,  in  diabetes,  375 

,    Increased   excretion    of,    in 

fever,  303 

Uric  acid  gravel,  Diet  in,  426 

and  glycosuria,  371-878 

Uricsemia,  Diet  in,  425 

caused  by  excess  of  albumin- 
ates, 425 

Urine,  Effect  of  animal  food  on,  291 

,  Tlie,  in  milk  cures,  527 

Utilisation  of  foods,  148 

Valentin's  meat-juice  in  typhoid,  323 
Value  of  peptones,  140 


592 


Food  in  Health  and  Disease. 


Variations  in  composition  of  milk, 
50 

of  diet  for  age,  203 

Veal  broth,  675 

,  Properties  and  composition 

of,  35 

Vegetable  acids,  importance  of  their 
salts,  27 

albumen,  66 

casein,- 07 

fibrin  or  gluten,  7,  67 

foods,  66 

induce  obesity,  290 

■ in  gout  and  m-icsemia,  427, 

428 

jelly  or  pectin,  9,  68,  93 

marrow,  88 

soups  for  diabetics,  575 

for  febrile  patients,  314 

Vegetables,  Dried,  etc.,  177 

,  Green,  85,  «6 

, ,  Konig's  analj'sis  of,  89 

Vegetarian  diet  in  chronic  rheuma- 
tism, 510 

Vegetarianism,  292 

,  Dr.  Raymond  on,  294 

,  Dr.  Treille  on,  294 

,  Jules  B6clard  on,  293 

,  Professor  Gublfer  on,  294 

,  Sir  W.  Roberts  on,  292 

Venison,  Properties  and  composi- 
tion of,  37 

Vermicelli,  73,  173 

milk  soup,  576 

Vichy  waters  in  dyspepsia,  855 

Vin  de  Grave,  123 

Vinegar,  131 

,  its  effects  on  digestion,  131 

to  be  avoided  in  anaemia,  466 

Vineyard  snail,  45 

Voit's  and  Pettenkofer's  experi- 
ments on  food  requirements,  186 

-stable  of  wasteful  and  insuffi- 
cient diet,  205 

Volnay,  121 

Vomiting,  infant,  Remedy  for,  260 

Voslauer,  121 

Waste  of  vegetable  food  in  Eng- 
land, 296 

Water,  96 

and  mineral  substances.  Glass 

of,  8 

,  Functions  of,  in  body,  28 

,    Importance    of,    to    febrile 

patients,  316,  322 


Water,  its  properties,  96 

Watercress,  88 

Weaning,  Date  of,  243 

Weber,  Dr.  Hermann,  on  food  to 
phthisis,  481 

Weir  Mitchell's  cure  for  obesity, 
450 

diet  in  nenrasthenia,  466, 

467 

on  causes  of  obesity,  441 

on  the  milk  COTe,  624 

Wet-nurse,  Milk  of,  51 

,  Qualities  of,  244 

Wheat,  Composition  and  properties 
of,  70,  71 

Whey,  257,  310,  564,  576 

and  "sweet"  whey,  55 

,  Composition  of,  56 

cure,  528 

,  Preparation  of,  257 

useful  in  fever,  310 

Whisky,  114 

White  of  egg,  Solution  of,  576 

or  acid  wines,  117,  122,  123 

wine  whey,  576 

Whole-meal,  72 

wheat-meal,  72,  170 

Wines,  116-125 

,  Aroma  of,  /18, 122 

,  Classification  of,  122 

,  Dry,  123 

,  Fining  of,  119 

,  Fortified,  119,  123 

,  Hungarian,  123 

in  gout,  431 

,  Plastering  of,  120 

,  Red,  117,  123 

,  Sparkling,  120 

suitable  to  the  gouty  consti- 
tution, 126 

,  Tannin  in,  118,  122 

,   tlieir    retarding    effects    ofl 

digestion,  125 

,  White  or  acid,  117,  122 

Woodcock,  39 

Wood's  glycerine  extract, 

Wort,  126 

Yam  (Dioscoreabafufas),  83 

Yeast,  165  . 

Young  children,  Dietary  of,  266 

Zasiadko    on    diets    in    chronic 

Bright's  disease,  419 
Zeltinger,  121 
Zymine  (Fairchild's),  543 


Piintedby  Cassell  &  Cojipasy,  Limited,  La  BoUe  Sauvage,  London,  B.C. 
20.497 


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